- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.96 / $3,063.00 / $11,481.00
| Facility | | $102.96 | $3,063.00 | $11,481.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.45 / $165.87 / $2,530.00
| Facility | | $74.45 | $165.87 | $2,530.00 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $14.89 / $14.89 / $14.89
| Facility | 53 | $14.89 | $14.89 | $14.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.00 / $2,204.00 / $6,116.00
| Facility | | $238.00 | $2,204.00 | $6,116.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $390.00 / $2,491.00 / $5,015.00
| Facility | | $390.00 | $2,491.00 | $5,015.00 |