- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,446.29 / $1,624.74 / $2,292.90
| Professional | | $1,446.29 | $1,624.74 | $2,292.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,493.47 / $1,757.03 / $2,604.09
| Professional | | $1,493.47 | $1,757.03 | $2,604.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,870.11 / $2,195.59 / $3,135.51
| Professional | | $1,870.11 | $2,195.59 | $3,135.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,452.69 / $1,617.06 / $2,516.15
| Professional | | $1,452.69 | $1,617.06 | $2,516.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,472.35 / $1,624.74 / $2,463.86
| Professional | | $1,472.35 | $1,624.74 | $2,463.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.09 / $2,048.15 / $2,739.11
| Professional | | $1,500.09 | $2,048.15 | $2,739.11 |