- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $7,413.10 / $8,912.51
| Facility | | $6,025.60 | $7,413.10 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $6,606.93 / $10,715.19
| Facility | | $6,456.54 | $6,606.93 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $7,413.10 / $11,748.98
| Facility | | $5,754.40 | $7,413.10 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $10,000.00 / $10,000.00
| Facility | | $4,786.30 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $8,317.64 / $12,589.25
| Facility | | $6,025.60 | $8,317.64 | $12,589.25 |