- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $197.51 / $221.89 / $478.51
| Facility | 54 | $197.51 | $221.89 | $478.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.02 / $295.85 / $638.01
| Professional | | $240.02 | $295.85 | $638.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $654.00 / $654.00 / $654.00
| Professional | | $654.00 | $654.00 | $654.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.23 / $464.78 / $629.88
| Professional | | $296.23 | $464.78 | $629.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.49 / $357.34 / $695.73
| Professional | | $274.49 | $357.34 | $695.73 |