- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.00 / $4,235.59 / $7,119.04
| Facility | | $2,906.00 | $4,235.59 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $699.28 / $1,106.08 / $2,045.76
| Professional | | $699.28 | $1,106.08 | $2,045.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.34 / $1,696.82 / $3,915.00
| Facility | | $1,061.34 | $1,696.82 | $3,915.00 |
- 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
- $1,257.44 / $1,657.91 / $2,020.28
| Facility | | $1,257.44 | $1,657.91 | $2,020.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.00 / $3,482.00 / $5,454.00
| Facility | | $1,775.00 | $3,482.00 | $5,454.00 |