- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,042.75 / $1,229.72 / $1,542.16
| Professional | | $1,042.75 | $1,229.72 | $1,542.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,282.03 / $1,659.10 / $2,352.92
| Professional | | $1,282.03 | $1,659.10 | $2,352.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,252.89 / $1,850.59 / $2,634.27
| Professional | | $1,252.89 | $1,850.59 | $2,634.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,536.68 / $1,777.94 / $2,727.45
| Professional | | $1,536.68 | $1,777.94 | $2,727.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,042.75 / $1,253.94 / $1,936.90
| Professional | | $1,042.75 | $1,253.94 | $1,936.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,163.89 / $1,687.64 / $2,466.98
| Professional | | $1,163.89 | $1,687.64 | $2,466.98 |