- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,505.56 / $7,947.29 / $10,831.44
| Professional | | $6,505.56 | $7,947.29 | $10,831.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,698.28 / $9,698.28 / $10,569.86
| Professional | | $9,698.28 | $9,698.28 | $10,569.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,777.03 / $10,777.03 / $10,777.03
| Professional | | $10,777.03 | $10,777.03 | $10,777.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,301.03 / $15,113.20 / $20,501.71
| Professional | | $12,301.03 | $15,113.20 | $20,501.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,785.07 / $7,591.96 / $11,620.16
| Professional | | $5,785.07 | $7,591.96 | $11,620.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,671.03 / $7,795.14 / $13,142.87
| Professional | | $6,671.03 | $7,795.14 | $13,142.87 |