- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $7,585.78
| Professional | | $3,090.30 | $3,981.07 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $5,011.87 / $6,760.83
| Professional | | $3,162.28 | $5,011.87 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,677.35 / $7,585.78
| Professional | | $1,905.46 | $4,677.35 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,011.87 / $6,918.31
| Professional | | $4,073.80 | $5,011.87 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $4,786.30 / $12,589.25
| Professional | | $3,890.45 | $4,786.30 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,011.87 / $7,244.36
| Professional | | $3,467.37 | $5,011.87 | $7,244.36 |