- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $615.63 / $2,331.21
| Facility | | $100.00 | $615.63 | $2,331.21 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $111.92 / $123.13 / $253.65
| Facility | 53 | $111.92 | $123.13 | $253.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,223.09 / $1,426.62 / $2,500.00
| Facility | | $1,223.09 | $1,426.62 | $2,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,306.21 / $1,306.21 / $1,351.93
| Facility | | $1,306.21 | $1,306.21 | $1,351.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $930.00 / $3,884.00 / $8,611.00
| Facility | | $930.00 | $3,884.00 | $8,611.00 |