- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,736.56 / $10,242.03 / $10,471.40
| Professional | | $7,736.56 | $10,242.03 | $10,471.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,450.06 / $6,450.06 / $8,386.70
| Professional | | $6,450.06 | $6,450.06 | $8,386.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,072.81 / $8,072.81 / $8,072.81
| Facility | | $8,072.81 | $8,072.81 | $8,072.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,861.89 / $8,072.81 / $8,072.81
| Professional | | $6,861.89 | $8,072.81 | $8,072.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,820.48 / $5,820.48 / $5,820.48
| Professional | | $5,820.48 | $5,820.48 | $5,820.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,335.76 / $4,371.04 / $5,684.54
| Professional | | $3,335.76 | $4,371.04 | $5,684.54 |