- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.42 / $1,842.00 / $7,205.81
| Facility | | $362.42 | $1,842.00 | $7,205.81 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $126.91 / $208.53 / $208.53
| Facility | 52 | $126.91 | $208.53 | $208.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,384.58 / $2,961.68 / $5,930.76
| Facility | | $1,384.58 | $2,961.68 | $5,930.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $875.00 / $908.00
| Facility | | $875.00 | $875.00 | $908.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.82 / $376.11 / $816.63
| Professional | | $243.82 | $376.11 | $816.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $578.00 / $2,873.00 / $7,384.00
| Facility | | $578.00 | $2,873.00 | $7,384.00 |