- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.59 / $1,698.98 / $2,061.67
| Professional | | $1,326.59 | $1,698.98 | $2,061.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,679.84 / $2,173.91 / $3,047.66
| Professional | | $1,679.84 | $2,173.91 | $3,047.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,631.20 / $2,444.62 / $3,477.22
| Professional | | $1,631.20 | $2,444.62 | $3,477.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,988.87 / $2,301.12 / $3,530.05
| Professional | | $1,988.87 | $2,301.12 | $3,530.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.59 / $1,878.61 / $2,061.67
| Professional | | $1,326.59 | $1,878.61 | $2,061.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,527.00 / $2,214.15 / $3,184.60
| Professional | | $1,527.00 | $2,214.15 | $3,184.60 |