- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $1,122.02 / $7,079.46
| Facility | | $109.65 | $1,122.02 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $125.89 / $316.23 / $912.01
| Facility | 52 | $125.89 | $316.23 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $114.82 / $446.68 / $776.25
| Facility | 53 | $114.82 | $446.68 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $138.04 / $398.11
| Professional | | $72.44 | $138.04 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $66.07 / $123.03 / $281.84
| Professional | 52 | $66.07 | $123.03 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $26.92 / $54.95 / $102.33
| Professional | 53 | $26.92 | $54.95 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,715.35 / $9,549.93
| Facility | | $1,513.56 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $123.03 / $234.42
| Professional | | $72.44 | $123.03 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $295.12 / $741.31
| Facility | | $50.12 | $295.12 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $87.10 / $87.10 / $87.10
| Facility | 52 | $87.10 | $87.10 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $21.38 / $21.38 / $21.38
| Facility | 53 | $21.38 | $21.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $134.90 / $269.15
| Professional | | $81.28 | $134.90 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $63.10 / $67.61 / $234.42
| Professional | 53 | $63.10 | $67.61 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $1,071.52 / $3,467.37
| Facility | | $213.80 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $114.82 / $199.53
| Professional | | $69.18 | $114.82 | $199.53 |