- 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
- $641.64 / $1,010.43 / $2,388.71
| Professional | | $641.64 | $1,010.43 | $2,388.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $971.32 / $1,562.32 / $2,962.51
| Facility | | $971.32 | $1,562.32 | $2,962.51 |
- 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
- $1,255.45 / $1,517.45 / $1,969.98
| Facility | | $1,255.45 | $1,517.45 | $1,969.98 |
- 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 |