- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $191.54 / $216.11 / $268.45
| Facility | 54 | $191.54 | $216.11 | $268.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.39 / $312.22 / $519.62
| Professional | | $255.39 | $312.22 | $519.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.20 / $335.00 / $483.19
| Professional | | $273.20 | $335.00 | $483.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.10 / $405.91 / $666.57
| Professional | | $296.10 | $405.91 | $666.57 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $989.74 / $989.74 / $989.74
| Facility | 54 | $989.74 | $989.74 | $989.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.29 / $496.88 / $2,554.08
| Professional | | $314.29 | $496.88 | $2,554.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.37 / $416.60 / $698.14
| Professional | | $308.37 | $416.60 | $698.14 |