- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $234.38 / $234.38 / $265.33
| Facility | 54 | $234.38 | $234.38 | $265.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.02 / $312.50 / $477.81
| Professional | | $240.02 | $312.50 | $477.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.45 / $430.22 / $695.25
| Professional | | $320.45 | $430.22 | $695.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.20 / $421.07 / $625.66
| Professional | | $307.20 | $421.07 | $625.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.79 / $486.89 / $693.55
| Professional | | $367.79 | $486.89 | $693.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.88 / $461.76 / $734.99
| Professional | | $316.88 | $461.76 | $734.99 |