- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $286.38 / $286.38 / $319.60
| Facility | 54 | $286.38 | $286.38 | $319.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.52 / $343.67 / $1,418.00
| Professional | | $257.52 | $343.67 | $1,418.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.39 / $407.04 / $645.66
| Professional | | $289.39 | $407.04 | $645.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.81 / $166.78 / $341.22
| Professional | | $28.81 | $166.78 | $341.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.08 / $513.71 / $730.51
| Professional | | $402.08 | $513.71 | $730.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.83 / $347.19 / $564.83
| Professional | | $276.83 | $347.19 | $564.83 |