- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,109.78 / $1,436.04 / $1,748.33
| Professional | | $1,109.78 | $1,436.04 | $1,748.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,397.10 / $1,808.01 / $2,533.89
| Professional | | $1,397.10 | $1,808.01 | $2,533.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,350.76 / $2,052.92 / $2,927.87
| Professional | | $1,350.76 | $2,052.92 | $2,927.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,652.10 / $1,911.48 / $2,932.31
| Professional | | $1,652.10 | $1,911.48 | $2,932.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,109.78 / $1,632.02 / $1,748.33
| Professional | | $1,109.78 | $1,632.02 | $1,748.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,328.74 / $1,869.17 / $2,523.36
| Professional | | $1,328.74 | $1,869.17 | $2,523.36 |