- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,004.71 / $1,150.58 / $1,408.12
| Professional | | $1,004.71 | $1,150.58 | $1,408.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,142.96 / $1,479.12 / $2,079.25
| Professional | | $1,142.96 | $1,479.12 | $2,079.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,109.52 / $1,614.02 / $2,361.39
| Professional | | $1,109.52 | $1,614.02 | $2,361.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,357.37 / $1,570.48 / $2,409.19
| Professional | | $1,357.37 | $1,570.48 | $2,409.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,004.71 / $1,169.86 / $1,738.51
| Professional | | $1,004.71 | $1,169.86 | $1,738.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,003.78 / $1,357.37 / $1,735.16
| Professional | | $1,003.78 | $1,357.37 | $1,735.16 |