- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $257.68 / $290.36 / $641.26
| Facility | 54 | $257.68 | $290.36 | $641.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.75 / $327.27 / $484.70
| Professional | | $248.75 | $327.27 | $484.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.00 / $317.79 / $480.18
| Professional | | $253.00 | $317.79 | $480.18 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $357.43 / $357.43 / $357.43
| Facility | 54 | $357.43 | $357.43 | $357.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.83 / $399.90 / $748.14
| Professional | | $280.83 | $399.90 | $748.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.16 / $168.16 / $168.16
| Professional | | $168.16 | $168.16 | $168.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.26 / $176.37 / $445.76
| Professional | | $34.26 | $176.37 | $445.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.92 / $340.32 / $774.82
| Professional | | $265.92 | $340.32 | $774.82 |