- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $214.03 / $239.64 / $379.60
| Facility | 54 | $214.03 | $239.64 | $379.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.29 / $323.76 / $595.27
| Professional | | $270.29 | $323.76 | $595.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.76 / $339.44 / $339.44
| Professional | | $194.76 | $339.44 | $339.44 |
- 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
- $301.94 / $421.10 / $860.97
| Professional | | $301.94 | $421.10 | $860.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.31 / $463.31 / $463.31
| Professional | | $463.31 | $463.31 | $463.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.55 / $351.38 / $490.31
| Professional | | $237.55 | $351.38 | $490.31 |