- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $229.50 / $248.88 / $374.67
| Facility | 54 | $229.50 | $248.88 | $374.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.52 / $320.10 / $539.47
| Professional | | $257.52 | $320.10 | $539.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.64 / $363.13 / $625.96
| Professional | | $280.64 | $363.13 | $625.96 |
- 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
- $296.54 / $438.37 / $683.53
| Professional | | $296.54 | $438.37 | $683.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.12 / $410.79 / $711.66
| Professional | | $286.12 | $410.79 | $711.66 |