- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,002.25 / $1,263.33 / $1,518.77
| Professional | | $1,002.25 | $1,263.33 | $1,518.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,444.26 / $1,542.18 / $2,128.34
| Professional | | $1,444.26 | $1,542.18 | $2,128.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,187.09 / $1,776.30 / $2,599.38
| Professional | | $1,187.09 | $1,776.30 | $2,599.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,497.11 / $1,732.16 / $2,657.22
| Professional | | $1,497.11 | $1,732.16 | $2,657.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,002.25 / $1,335.07 / $1,518.77
| Professional | | $1,002.25 | $1,335.07 | $1,518.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,032.77 / $1,450.14 / $2,401.59
| Professional | | $1,032.77 | $1,450.14 | $2,401.59 |