- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,971.34 / $5,848.63 / $10,106.40
| Facility | | $4,971.34 | $5,848.63 | $10,106.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,678.89 / $4,854.35 / $5,436.88
| Professional | | $4,678.89 | $4,854.35 | $5,436.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,039.06 / $5,743.36 / $11,886.58
| Facility | | $2,039.06 | $5,743.36 | $11,886.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,971.34 / $5,068.81 / $5,738.61
| Professional | | $4,971.34 | $5,068.81 | $5,738.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,971.34 / $4,971.34 / $5,244.99
| Facility | | $4,971.34 | $4,971.34 | $5,244.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,971.34 / $4,971.34 / $4,971.34
| Professional | | $4,971.34 | $4,971.34 | $4,971.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,044.07 / $13,746.97 / $13,746.97
| Facility | | $13,044.07 | $13,746.97 | $13,746.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,873.85 / $5,020.56 / $5,799.89
| Professional | | $4,873.85 | $5,020.56 | $5,799.89 |