- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,176.15 / $1,334.54 / $1,611.21
| Professional | | $1,176.15 | $1,334.54 | $1,611.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,337.79 / $1,731.26 / $2,458.33
| Professional | | $1,337.79 | $1,731.26 | $2,458.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,309.48 / $1,933.45 / $2,749.60
| Professional | | $1,309.48 | $1,933.45 | $2,749.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,605.52 / $1,857.59 / $2,849.64
| Professional | | $1,605.52 | $1,857.59 | $2,849.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,176.15 / $1,611.21 / $1,731.67
| Professional | | $1,176.15 | $1,611.21 | $1,731.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,214.63 / $1,735.34 / $2,547.41
| Professional | | $1,214.63 | $1,735.34 | $2,547.41 |