- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,179.97 / $1,377.75 / $1,730.30
| Professional | | $1,179.97 | $1,377.75 | $1,730.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,435.23 / $1,857.36 / $2,635.05
| Professional | | $1,435.23 | $1,857.36 | $2,635.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,402.42 / $2,076.36 / $2,948.49
| Professional | | $1,402.42 | $2,076.36 | $2,948.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,720.94 / $1,991.13 / $3,054.50
| Professional | | $1,720.94 | $1,991.13 | $3,054.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,179.97 / $1,419.35 / $2,165.17
| Professional | | $1,179.97 | $1,419.35 | $2,165.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,315.03 / $1,864.95 / $2,728.93
| Professional | | $1,315.03 | $1,864.95 | $2,728.93 |