- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,373.00 / $1,495.90 / $1,665.52
| Professional | | $1,373.00 | $1,495.90 | $1,665.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,314.77 / $1,490.74 / $1,703.91
| Professional | | $1,314.77 | $1,490.74 | $1,703.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,146.43 / $1,536.67 / $3,080.36
| Professional | | $1,146.43 | $1,536.67 | $3,080.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,257.52 / $1,622.20 / $2,665.76
| Professional | | $1,257.52 | $1,622.20 | $2,665.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,059.21 / $1,419.57 / $2,704.57
| Professional | | $1,059.21 | $1,419.57 | $2,704.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $999.85 / $999.85 / $1,761.84
| Professional | | $999.85 | $999.85 | $1,761.84 |