- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,374.88 / $5,294.18 / $6,520.22
| Facility | | $4,374.88 | $5,294.18 | $6,520.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,282.04 / $4,676.14 / $4,757.16
| Facility | | $4,282.04 | $4,676.14 | $4,757.16 |
- 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
- $4,177.82 / $5,401.13 / $8,463.49
| Facility | | $4,177.82 | $5,401.13 | $8,463.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,121.24 / $6,825.13 / $9,007.34
| Facility | | $5,121.24 | $6,825.13 | $9,007.34 |