- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.65 / $236.49 / $1,274.00
| Facility | | $231.65 | $236.49 | $1,274.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.76 / $236.49 / $560.59
| Professional | | $225.76 | $236.49 | $560.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.39 / $312.66 / $515.89
| Professional | | $281.39 | $312.66 | $515.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.02 / $605.83 / $1,053.16
| Professional | | $271.02 | $605.83 | $1,053.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.04 / $564.55 / $564.55
| Professional | | $256.04 | $564.55 | $564.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.65 / $338.23 / $714.93
| Professional | | $192.65 | $338.23 | $714.93 |