- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,757.23 / $6,967.00 / $8,580.44
| Facility | | $5,757.23 | $6,967.00 | $8,580.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,635.05 / $6,153.70 / $6,260.30
| Facility | | $5,635.05 | $6,153.70 | $6,260.30 |
- 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
- $5,497.90 / $7,107.75 / $11,137.74
| Facility | | $5,497.90 | $7,107.75 | $11,137.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,739.42 / $8,981.70 / $11,853.43
| Facility | | $6,739.42 | $8,981.70 | $11,853.43 |