- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $274.27 / $309.30 / $404.60
| Facility | 54 | $274.27 | $309.30 | $404.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.29 / $343.67 / $539.47
| Professional | | $270.29 | $343.67 | $539.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.95 / $410.53 / $450.46
| Professional | | $348.95 | $410.53 | $450.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.07 / $419.03 / $668.65
| Professional | | $293.07 | $419.03 | $668.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.54 / $430.63 / $2,554.08
| Professional | | $326.54 | $430.63 | $2,554.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.54 / $380.94 / $550.90
| Professional | | $326.54 | $380.94 | $550.90 |