- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,198.39 / $1,424.31 / $1,831.40
| Professional | | $1,198.39 | $1,424.31 | $1,831.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,483.93 / $1,920.39 / $2,700.06
| Professional | | $1,483.93 | $1,920.39 | $2,700.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,433.07 / $2,185.98 / $3,105.16
| Professional | | $1,433.07 | $2,185.98 | $3,105.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,763.39 / $2,040.24 / $3,129.84
| Professional | | $1,763.39 | $2,040.24 | $3,129.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,198.39 / $1,424.31 / $1,831.40
| Professional | | $1,198.39 | $1,424.31 | $1,831.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,391.86 / $1,956.12 / $2,843.47
| Professional | | $1,391.86 | $1,956.12 | $2,843.47 |