- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $5,370.32 / $9,120.11
| Facility | | $269.15 | $5,370.32 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $407.38 / $407.38 / $407.38
| Facility | 52 | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,548.82 / $3,548.13
| Facility | | $741.31 | $1,548.82 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $575.44 / $1,148.15
| Facility | | $331.13 | $575.44 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $263.03 / $263.03 / $263.03
| Facility | 52 | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $389.05
| Professional | | $331.13 | $331.13 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $295.12 / $457.09
| Facility | | $194.98 | $295.12 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $6,309.57 / $10,000.00
| Facility | | $616.60 | $6,309.57 | $10,000.00 |