- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,904.07 / $5,210.58 / $7,356.11
| Facility | | $4,904.07 | $5,210.58 | $7,356.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,904.07 / $5,087.97 / $5,210.58
| Professional | | $4,904.07 | $5,087.97 | $5,210.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,147.42 / $5,363.83 / $8,975.23
| Facility | | $2,147.42 | $5,363.83 | $8,975.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,378.64 / $5,149.28 / $5,502.64
| Professional | | $4,378.64 | $5,149.28 | $5,502.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,210.58 / $5,210.58 / $5,210.58
| Facility | | $5,210.58 | $5,210.58 | $5,210.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,210.58 / $5,210.58 / $5,210.58
| Professional | | $5,210.58 | $5,210.58 | $5,210.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,108.41 / $5,108.41 / $6,130.09
| Professional | | $5,108.41 | $5,108.41 | $6,130.09 |