- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $322.54 / $360.09 / $490.64
| Facility | 54 | $322.54 | $360.09 | $490.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.52 / $324.48 / $745.87
| Professional | | $257.52 | $324.48 | $745.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.76 / $535.80 / $734.88
| Professional | | $276.76 | $535.80 | $734.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.51 / $535.94 / $828.80
| Professional | | $360.51 | $535.94 | $828.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.37 / $448.02 / $561.08
| Professional | | $302.37 | $448.02 | $561.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.07 / $576.20 / $999.64
| Professional | | $291.07 | $576.20 | $999.64 |