- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $660.69 / $660.69 / $660.69
| Facility | 54 | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $346.74 / $741.31
| Professional | | $269.15 | $346.74 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $363.08 / $724.44
| Professional | | $245.47 | $363.08 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $354.81 / $354.81 / $354.81
| Facility | 54 | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $436.52 / $977.24
| Professional | | $288.40 | $436.52 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $354.81 / $676.08
| Professional | | $245.47 | $354.81 | $676.08 |