- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.87 / $2,984.00 / $6,427.45
| Facility | | $126.87 | $2,984.00 | $6,427.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $862.00 / $1,785.00 / $4,773.00
| Facility | | $862.00 | $1,785.00 | $4,773.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,213.00 / $2,213.00 / $2,213.00
| Facility | | $2,213.00 | $2,213.00 | $2,213.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.05 / $160.08 / $2,672.00
| Facility | | $98.05 | $160.08 | $2,672.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $214.05 / $6,012.68 / $6,012.68
| Facility | 52 | $214.05 | $6,012.68 | $6,012.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.00 / $2,332.00 / $3,041.00
| Facility | | $1,380.00 | $2,332.00 | $3,041.00 |