- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,201.94 / $1,619.54 / $1,984.38
| Professional | | $1,201.94 | $1,619.54 | $1,984.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,596.62 / $1,756.28 / $2,510.36
| Professional | | $1,596.62 | $1,756.28 | $2,510.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,559.84 / $1,991.24 / $2,803.59
| Professional | | $1,559.84 | $1,991.24 | $2,803.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,467.13 / $1,889.54 / $2,898.66
| Professional | | $1,467.13 | $1,889.54 | $2,898.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,201.94 / $1,619.54 / $1,915.09
| Professional | | $1,201.94 | $1,619.54 | $1,915.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,453.68 / $1,878.71 / $2,555.14
| Professional | | $1,453.68 | $1,878.71 | $2,555.14 |