- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $211.01 / $238.33 / $397.21
| Facility | 54 | $211.01 | $238.33 | $397.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.75 / $303.99 / $428.46
| Professional | | $254.75 | $303.99 | $428.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.13 / $372.13 / $372.13
| Professional | | $372.13 | $372.13 | $372.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.07 / $273.20 / $377.01
| Professional | | $216.07 | $273.20 | $377.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.38 / $376.06 / $564.09
| Professional | | $313.38 | $376.06 | $564.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.75 / $354.03 / $614.91
| Professional | | $268.75 | $354.03 | $614.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.94 / $348.90 / $602.37
| Professional | | $262.94 | $348.90 | $602.37 |