- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.79 / $914.82 / $5,261.94
| Facility | | $116.79 | $914.82 | $5,261.94 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $32.65 / $45.70 / $70.59
| Facility | 52 | $32.65 | $45.70 | $70.59 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $12.58 / $18.88 / $29.52
| Facility | 53 | $12.58 | $18.88 | $29.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.26 / $112.43 / $262.95
| Professional | | $73.26 | $112.43 | $262.95 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $30.86 / $47.47 / $94.52
| Professional | 52 | $30.86 | $47.47 | $94.52 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $12.48 / $19.42 / $41.75
| Professional | 53 | $12.48 | $19.42 | $41.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,691.00 / $2,971.00 / $4,636.00
| Facility | | $1,691.00 | $2,971.00 | $4,636.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.06 / $113.56 / $188.85
| Professional | | $78.06 | $113.56 | $188.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $73.58 / $74.28 / $99.38
| Facility | | $73.58 | $74.28 | $99.38 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $86.34 / $86.34 / $86.34
| Facility | 52 | $86.34 | $86.34 | $86.34 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $21.59 / $21.59 / $21.59
| Facility | 53 | $21.59 | $21.59 | $21.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.72 / $131.55 / $224.18
| Professional | | $82.72 | $131.55 | $224.18 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $308.58 / $308.58 / $308.58
| Professional | 53 | $308.58 | $308.58 | $308.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $376.00 / $1,221.00 / $2,883.00
| Facility | | $376.00 | $1,221.00 | $2,883.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.92 / $141.94 / $226.80
| Professional | | $100.92 | $141.94 | $226.80 |