- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,274.58 / $1,362.15 / $2,124.46
| Professional | | $1,274.58 | $1,362.15 | $2,124.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,475.82 / $1,817.44 / $2,681.98
| Professional | | $1,475.82 | $1,817.44 | $2,681.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,749.56 / $2,124.46 / $2,987.17
| Professional | | $1,749.56 | $2,124.46 | $2,987.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,558.59 / $1,734.95 / $2,699.58
| Professional | | $1,558.59 | $1,734.95 | $2,699.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,274.58 / $1,482.43 / $2,124.46
| Professional | | $1,274.58 | $1,482.43 | $2,124.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,415.82 / $2,005.35 / $2,420.25
| Professional | | $1,415.82 | $2,005.35 | $2,420.25 |