- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,123.30 / $1,384.09 / $1,674.79
| Professional | | $1,123.30 | $1,384.09 | $1,674.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,411.57 / $1,826.74 / $2,727.83
| Professional | | $1,411.57 | $1,826.74 | $2,727.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,286.13 / $2,009.75 / $2,874.68
| Professional | | $1,286.13 | $2,009.75 | $2,874.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,781.53 / $2,061.23 / $3,162.04
| Professional | | $1,781.53 | $2,061.23 | $3,162.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,123.30 / $1,507.45 / $1,674.79
| Professional | | $1,123.30 | $1,507.45 | $1,674.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,160.40 / $1,781.53 / $2,821.87
| Professional | | $1,160.40 | $1,781.53 | $2,821.87 |