- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $6,760.83 / $10,471.29
| Professional | | $5,248.07 | $6,760.83 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $8,128.31 / $10,000.00
| Facility | | $8,128.31 | $8,128.31 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,128.31 / $11,220.18 / $15,848.93
| Professional | | $8,128.31 | $11,220.18 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,882.50 / $12,882.50 / $12,882.50
| Professional | | $12,882.50 | $12,882.50 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,762.47 / $12,882.50 / $14,791.08
| Professional | | $7,762.47 | $12,882.50 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $8,128.31 / $9,549.93
| Facility | | $7,943.28 | $8,128.31 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,079.46 / $10,000.00 / $13,803.84
| Professional | | $7,079.46 | $10,000.00 | $13,803.84 |