- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,137.63 / $1,605.16 / $1,672.97
| Professional | | $1,137.63 | $1,605.16 | $1,672.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,439.23 / $1,862.54 / $2,831.02
| Professional | | $1,439.23 | $1,862.54 | $2,831.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.17 / $2,166.07 / $3,058.09
| Professional | | $1,548.17 | $2,166.07 | $3,058.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,780.70 / $2,060.27 / $3,160.56
| Professional | | $1,780.70 | $2,060.27 | $3,160.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,137.63 / $1,672.97 / $2,146.46
| Professional | | $1,137.63 | $1,672.97 | $2,146.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,370.11 / $1,947.22 / $2,607.88
| Professional | | $1,370.11 | $1,947.22 | $2,607.88 |