- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,238.84 / $7,549.82 / $9,298.21
| Facility | | $6,238.84 | $7,549.82 | $9,298.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,106.44 / $6,668.48 / $6,784.00
| Facility | | $6,106.44 | $6,668.48 | $6,784.00 |
- 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
- $5,957.82 / $7,702.33 / $12,069.45
| Facility | | $5,957.82 | $7,702.33 | $12,069.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,303.20 / $9,733.04 / $12,845.01
| Facility | | $7,303.20 | $9,733.04 | $12,845.01 |