- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $215.06 / $236.33 / $266.18
| Facility | 54 | $215.06 | $236.33 | $266.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.02 / $315.11 / $1,418.00
| Professional | | $240.02 | $315.11 | $1,418.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.67 / $336.58 / $492.30
| Professional | | $294.67 | $336.58 | $492.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.45 / $378.13 / $567.85
| Professional | | $266.45 | $378.13 | $567.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.94 / $348.39 / $570.10
| Professional | | $1.94 | $348.39 | $570.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.32 / $316.72 / $581.91
| Professional | | $1.32 | $316.72 | $581.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.26 / $358.19 / $580.65
| Professional | | $276.26 | $358.19 | $580.65 |