- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $603.00 / $2,912.34 / $7,119.04
| Facility | | $603.00 | $2,912.34 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.06 / $583.27 / $977.20
| Professional | | $380.06 | $583.27 | $977.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.98 / $1,003.23 / $4,645.00
| Facility | | $510.98 | $1,003.23 | $4,645.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $3,154.80 / $3,154.80 / $3,154.80
| Facility | 54 | $3,154.80 | $3,154.80 | $3,154.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $673.00 / $1,074.23 / $1,597.11
| Facility | | $673.00 | $1,074.23 | $1,597.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,101.36 / $3,894.74 / $6,267.00
| Facility | | $2,101.36 | $3,894.74 | $6,267.00 |