- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $202.82 / $229.51 / $303.43
| Facility | 54 | $202.82 | $229.51 | $303.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.75 / $306.01 / $519.25
| Professional | | $254.75 | $306.01 | $519.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.22 / $439.49 / $950.12
| Professional | | $291.22 | $439.49 | $950.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.39 / $459.13 / $560.34
| Professional | | $309.39 | $459.13 | $560.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.31 / $384.43 / $719.44
| Professional | | $286.31 | $384.43 | $719.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.55 / $399.92 / $994.51
| Professional | | $280.55 | $399.92 | $994.51 |