- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,056.18 / $1,401.65 / $1,551.41
| Professional | | $1,056.18 | $1,401.65 | $1,551.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,328.52 / $1,719.26 / $2,624.60
| Professional | | $1,328.52 | $1,719.26 | $2,624.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,437.09 / $2,008.33 / $2,838.68
| Professional | | $1,437.09 | $2,008.33 | $2,838.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,650.86 / $1,910.04 / $2,930.11
| Professional | | $1,650.86 | $1,910.04 | $2,930.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,056.18 / $1,551.41 / $1,945.04
| Professional | | $1,056.18 | $1,551.41 | $1,945.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,136.81 / $1,807.36 / $2,851.65
| Professional | | $1,136.81 | $1,807.36 | $2,851.65 |