- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $780.70 / $2,015.66 / $8,108.37
| Facility | | $780.70 | $2,015.66 | $8,108.37 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $585.53 / $1,066.40 / $1,204.53
| Facility | 54 | $585.53 | $1,066.40 | $1,204.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,202.15 / $8,369.71 / $18,255.41
| Facility | | $2,202.15 | $8,369.71 | $18,255.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.00 / $1,631.14 / $1,820.98
| Facility | | $620.00 | $1,631.14 | $1,820.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $887.33 / $1,307.03 / $3,641.90
| Professional | | $887.33 | $1,307.03 | $3,641.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,095.00 / $2,622.00 / $5,026.00
| Facility | | $1,095.00 | $2,622.00 | $5,026.00 |