- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,897.79 / $6,309.57
| Professional | | $2,754.23 | $4,897.79 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $5,754.40 / $8,912.51
| Professional | | $3,548.13 | $5,754.40 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,495.41 / $8,912.51
| Professional | | $1,819.70 | $5,495.41 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,786.30 / $5,754.40 / $7,413.10
| Professional | | $4,786.30 | $5,754.40 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,495.41 / $7,079.46
| Professional | | $1,819.70 | $5,495.41 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,888.44 / $7,585.78
| Professional | | $1,862.09 | $5,888.44 | $7,585.78 |