- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,441.92 / $6,585.44 / $8,110.51
| Facility | | $5,441.92 | $6,585.44 | $8,110.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,326.43 / $5,816.68 / $5,917.44
| Facility | | $5,326.43 | $5,816.68 | $5,917.44 |
- 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
- $5,196.80 / $6,718.47 / $10,527.76
| Facility | | $5,196.80 | $6,718.47 | $10,527.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,370.32 / $8,489.79 / $11,204.25
| Facility | | $6,370.32 | $8,489.79 | $11,204.25 |