- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $302.79 / $2,331.21
| Facility | | $100.00 | $302.79 | $2,331.21 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $120.16 / $227.09 / $281.38
| Facility | 54 | $120.16 | $227.09 | $281.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,223.09 / $1,359.00 / $3,300.00
| Facility | | $1,223.09 | $1,359.00 | $3,300.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.71 / $160.71 / $160.71
| Facility | | $160.71 | $160.71 | $160.71 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $112.50 / $112.50 / $112.50
| Facility | 54 | $112.50 | $112.50 | $112.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,448.00 / $7,448.00 / $7,448.00
| Facility | | $7,448.00 | $7,448.00 | $7,448.00 |