- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,229.47 / $6,328.35 / $7,793.89
| Facility | | $5,229.47 | $6,328.35 | $7,793.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,118.50 / $5,589.60 / $5,686.43
| Facility | | $5,118.50 | $5,589.60 | $5,686.43 |
- 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
- $4,993.92 / $6,456.19 / $10,116.77
| Facility | | $4,993.92 | $6,456.19 | $10,116.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,121.63 / $8,158.37 / $10,766.85
| Facility | | $6,121.63 | $8,158.37 | $10,766.85 |