- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $219.69 / $219.69 / $247.30
| Facility | 54 | $219.69 | $219.69 | $247.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.02 / $292.92 / $349.62
| Professional | | $240.02 | $292.92 | $349.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.13 / $731.76 / $864.57
| Professional | | $614.13 | $731.76 | $864.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.58 / $764.57 / $1,085.47
| Professional | | $350.58 | $764.57 | $1,085.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.32 / $604.89 / $2,261.92
| Professional | | $340.32 | $604.89 | $2,261.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.32 / $545.09 / $711.66
| Professional | | $340.32 | $545.09 | $711.66 |