- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $2,630.27 / $7,943.28
| Facility | | $128.82 | $2,630.27 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,801.89 / $9,549.93
| Facility | | $1,548.82 | $3,801.89 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $281.84 / $1,000.00
| Facility | | $123.03 | $281.84 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $24.55 / $24.55 / $24.55
| Facility | 53 | $24.55 | $24.55 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,862.09 / $4,677.35
| Facility | | $446.68 | $1,862.09 | $4,677.35 |