- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $231.79 / $231.79 / $260.70
| Facility | 54 | $231.79 | $231.79 | $260.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.52 / $309.05 / $354.90
| Professional | | $257.52 | $309.05 | $354.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.05 / $385.92 / $451.78
| Professional | | $281.05 | $385.92 | $451.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.63 / $377.70 / $511.57
| Professional | | $271.63 | $377.70 | $511.57 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $989.74 / $989.74 / $989.74
| Facility | 54 | $989.74 | $989.74 | $989.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.26 / $362.47 / $2,554.08
| Professional | | $272.26 | $362.47 | $2,554.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.43 / $334.42 / $479.85
| Professional | | $269.43 | $334.42 | $479.85 |