- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,013.37 / $1,087.74 / $1,409.30
| Professional | | $1,013.37 | $1,087.74 | $1,409.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,342.13 / $1,563.59 / $2,258.56
| Professional | | $1,342.13 | $1,563.59 | $2,258.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,277.38 / $1,676.25 / $2,606.80
| Professional | | $1,277.38 | $1,676.25 | $2,606.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,307.16 / $1,683.52 / $2,582.60
| Professional | | $1,307.16 | $1,683.52 | $2,582.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,013.37 / $1,409.30 / $1,409.30
| Professional | | $1,013.37 | $1,409.30 | $1,409.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,019.68 / $1,596.73 / $2,378.76
| Professional | | $1,019.68 | $1,596.73 | $2,378.76 |