- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,973.52 / $7,228.75 / $8,902.79
| Facility | | $5,973.52 | $7,228.75 | $8,902.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,846.75 / $6,384.89 / $6,495.49
| Facility | | $5,846.75 | $6,384.89 | $6,495.49 |
- 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
- $5,704.45 / $7,374.78 / $11,556.18
| Facility | | $5,704.45 | $7,374.78 | $11,556.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,992.61 / $9,319.14 / $12,298.75
| Facility | | $6,992.61 | $9,319.14 | $12,298.75 |