- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,120.84 / $1,396.24 / $1,696.55
| Professional | | $1,120.84 | $1,396.24 | $1,696.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,403.81 / $1,816.70 / $2,574.46
| Professional | | $1,403.81 | $1,816.70 | $2,574.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,284.75 / $1,992.54 / $2,881.71
| Professional | | $1,284.75 | $1,992.54 | $2,881.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,681.36 / $1,945.33 / $2,984.25
| Professional | | $1,681.36 | $1,945.33 | $2,984.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,120.84 / $1,437.71 / $1,696.55
| Professional | | $1,120.84 | $1,437.71 | $1,696.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,167.59 / $1,856.20 / $2,664.34
| Professional | | $1,167.59 | $1,856.20 | $2,664.34 |