- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $167.52 / $371.84 / $4,846.00
| Facility | | $167.52 | $371.84 | $4,846.00 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $30.27 / $91.11 / $186.02
| Facility | 53 | $30.27 | $91.11 | $186.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,636.00 / $3,635.00 / $5,445.00
| Facility | | $1,636.00 | $3,635.00 | $5,445.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.60 / $181.48 / $387.83
| Facility | | $139.60 | $181.48 | $387.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.52 / $402.00 / $655.97
| Facility | | $263.52 | $402.00 | $655.97 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $52.70 / $52.70 / $52.70
| Facility | 53 | $52.70 | $52.70 | $52.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,817.00 / $5,402.00
| Facility | | $900.00 | $3,817.00 | $5,402.00 |