- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.70 / $2,414.00 / $5,691.00
| Facility | | $170.70 | $2,414.00 | $5,691.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,530.00 / $2,530.00 / $2,530.00
| Facility | | $2,530.00 | $2,530.00 | $2,530.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.06 / $159.12 / $411.65
| Facility | | $54.06 | $159.12 | $411.65 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $51.47 / $51.47 / $51.47
| Facility | 53 | $51.47 | $51.47 | $51.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $899.00 / $1,729.00 / $2,539.00
| Facility | | $899.00 | $1,729.00 | $2,539.00 |