- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,370.96 / $1,403.82 / $1,469.63
| Professional | | $1,370.96 | $1,403.82 | $1,469.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,372.04 / $1,674.95 / $2,574.88
| Professional | | $1,372.04 | $1,674.95 | $2,574.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,627.29 / $1,985.98 / $2,773.63
| Professional | | $1,627.29 | $1,985.98 | $2,773.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,436.39 / $1,598.92 / $2,487.92
| Professional | | $1,436.39 | $1,598.92 | $2,487.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,363.18 / $1,403.82 / $1,469.63
| Professional | | $1,363.18 | $1,403.82 | $1,469.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,377.08 / $1,867.80 / $2,415.26
| Professional | | $1,377.08 | $1,867.80 | $2,415.26 |