- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,024.86 / $1,229.26 / $1,517.30
| Professional | | $1,024.86 | $1,229.26 | $1,517.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,235.08 / $1,598.34 / $2,356.71
| Professional | | $1,235.08 | $1,598.34 | $2,356.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,254.07 / $1,825.16 / $2,537.64
| Professional | | $1,254.07 | $1,825.16 | $2,537.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,539.15 / $1,780.80 / $2,731.84
| Professional | | $1,539.15 | $1,780.80 | $2,731.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,024.86 / $1,398.49 / $1,517.30
| Professional | | $1,024.86 | $1,398.49 | $1,517.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,153.15 / $1,622.21 / $2,441.37
| Professional | | $1,153.15 | $1,622.21 | $2,441.37 |