- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.44 / $665.52 / $3,949.00
| Facility | | $549.44 | $665.52 | $3,949.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.71 / $277.54 / $326.89
| Professional | | $230.71 | $277.54 | $326.89 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $171.03 / $209.60 / $245.17
| Professional | 54 | $171.03 | $209.60 | $245.17 |
- Facility/Professional
- Professional
- Modifier
- 55
- Low / Median / High Price
- $32.07 / $41.92 / $49.03
| Professional | 55 | $32.07 | $41.92 | $49.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.00 / $418.00 / $418.00
| Facility | | $418.00 | $418.00 | $418.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.17 / $255.23 / $420.03
| Professional | | $187.17 | $255.23 | $420.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.59 / $252.59 / $401.19
| Professional | | $252.59 | $252.59 | $401.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $359.43 / $359.43 / $369.16
| Professional | 50 | $359.43 | $359.43 | $369.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.12 / $281.56 / $553.64
| Professional | | $209.12 | $281.56 | $553.64 |