- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.75 / $2,600.00 / $7,416.00
| Facility | | $362.75 | $2,600.00 | $7,416.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $140.26 / $140.26 / $750.08
| Facility | 52 | $140.26 | $140.26 | $750.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,427.00 / $7,478.00 / $13,989.00
| Facility | | $4,427.00 | $7,478.00 | $13,989.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $280.51 / $1,250.13 / $2,179.11
| Facility | | $280.51 | $1,250.13 | $2,179.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.23 / $884.05 / $2,209.02
| Professional | | $306.23 | $884.05 | $2,209.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,645.00 / $6,090.00 / $14,057.00
| Facility | | $2,645.00 | $6,090.00 | $14,057.00 |