- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,297.42 / $11,927.55 / $16,249.12
| Professional | | $8,297.42 | $11,927.55 | $16,249.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,033.53 / $10,606.94 / $11,937.29
| Professional | | $7,033.53 | $10,606.94 | $11,937.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,777.82 / $11,155.72 / $11,155.72
| Facility | | $8,777.82 | $11,155.72 | $11,155.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,347.76 / $11,155.72 / $11,155.72
| Professional | | $1,347.76 | $11,155.72 | $11,155.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,836.80 / $10,743.08 / $13,829.04
| Facility | | $6,836.80 | $10,743.08 | $13,829.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,278.60 / $6,040.36 / $12,322.18
| Professional | | $4,278.60 | $6,040.36 | $12,322.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,253.81 / $6,040.36 / $9,820.85
| Professional | | $4,253.81 | $6,040.36 | $9,820.85 |