- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,755.87 / $9,256.75 / $9,256.75
| Professional | | $6,755.87 | $9,256.75 | $9,256.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,671.03 / $8,683.19 / $8,683.19
| Professional | | $6,671.03 | $8,683.19 | $8,683.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,092.81 / $10,777.03 / $10,777.03
| Professional | | $1,092.81 | $10,777.03 | $10,777.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,500.78 / $9,256.75 / $9,256.75
| Professional | | $6,500.78 | $9,256.75 | $9,256.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,346.93 / $5,921.72 / $13,842.58
| Professional | | $4,346.93 | $5,921.72 | $13,842.58 |