- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.00 / $3,576.15 / $7,119.04
| Facility | | $2,218.00 | $3,576.15 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.83 / $662.17 / $1,141.03
| Professional | | $393.83 | $662.17 | $1,141.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $626.91 / $1,025.25 / $1,966.00
| Facility | | $626.91 | $1,025.25 | $1,966.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,347.91 / $1,347.91 / $1,347.91
| Facility | 54 | $1,347.91 | $1,347.91 | $1,347.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $856.26 / $1,028.39 / $1,597.11
| Facility | | $856.26 | $1,028.39 | $1,597.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,640.00 / $2,126.00
| Facility | | $1,204.00 | $1,640.00 | $2,126.00 |