- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,171.55 / $7,468.39 / $9,197.93
| Facility | | $6,171.55 | $7,468.39 | $9,197.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,040.58 / $6,596.55 / $6,710.83
| Facility | | $6,040.58 | $6,596.55 | $6,710.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.00 / $150.00 / $150.00
| Facility | | $150.00 | $150.00 | $150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,893.56 / $7,619.26 / $11,939.27
| Facility | | $5,893.56 | $7,619.26 | $11,939.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,224.43 / $9,628.07 / $12,706.46
| Facility | | $7,224.43 | $9,628.07 | $12,706.46 |