- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,266.58 / $1,355.64 / $2,100.96
| Professional | | $1,266.58 | $1,355.64 | $2,100.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,460.64 / $1,807.08 / $2,650.89
| Professional | | $1,460.64 | $1,807.08 | $2,650.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,728.21 / $2,100.96 / $2,960.13
| Professional | | $1,728.21 | $2,100.96 | $2,960.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,549.71 / $1,725.06 / $2,684.19
| Professional | | $1,549.71 | $1,725.06 | $2,684.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,266.58 / $1,481.70 / $2,100.96
| Professional | | $1,266.58 | $1,481.70 | $2,100.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,467.18 / $1,981.60 / $2,699.88
| Professional | | $1,467.18 | $1,981.60 | $2,699.88 |