- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,728.79 / $7,690.05 / $7,745.48
| Facility | | $6,728.79 | $7,690.05 | $7,745.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,408.38 / $6,728.79 / $8,651.31
| Professional | | $6,408.38 | $6,728.79 | $8,651.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,170.05 / $5,170.05 / $5,687.06
| Facility | | $5,170.05 | $5,170.05 | $5,687.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,370.09 / $6,408.38 / $6,408.38
| Facility | | $3,370.09 | $6,408.38 | $6,408.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,408.38 / $6,408.38 / $6,408.38
| Professional | | $6,408.38 | $6,408.38 | $6,408.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,152.04 / $6,408.38 / $8,330.89
| Professional | | $6,152.04 | $6,408.38 | $8,330.89 |