- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,217.75 / $16,608.54 / $16,608.54
| Professional | | $16,217.75 | $16,608.54 | $16,608.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,631.57 / $15,631.57 / $15,631.57
| Professional | | $15,631.57 | $15,631.57 | $15,631.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,608.54 / $16,608.54 / $16,608.54
| Professional | | $16,608.54 | $16,608.54 | $16,608.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,860.06 / $15,778.12 / $18,562.49
| Professional | | $3,860.06 | $15,778.12 | $18,562.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,282.88 / $16,282.88 / $19,539.46
| Professional | | $16,282.88 | $16,282.88 | $19,539.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,484.39 / $6,484.39 / $6,484.39
| Professional | | $6,484.39 | $6,484.39 | $6,484.39 |