- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,188.03 / $1,443.79 / $1,885.40
| Professional | | $1,188.03 | $1,443.79 | $1,885.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,241.44 / $1,606.57 / $2,459.52
| Professional | | $1,241.44 | $1,606.57 | $2,459.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,019.72 / $1,656.44 / $2,560.85
| Professional | | $1,019.72 | $1,656.44 | $2,560.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,485.16 / $1,779.37 / $2,636.01
| Professional | | $1,485.16 | $1,779.37 | $2,636.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,188.03 / $1,443.79 / $1,885.40
| Professional | | $1,188.03 | $1,443.79 | $1,885.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,165.61 / $1,485.16 / $2,362.89
| Professional | | $1,165.61 | $1,485.16 | $2,362.89 |