- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,971.60 / $7,226.42 / $8,899.93
| Facility | | $5,971.60 | $7,226.42 | $8,899.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,844.87 / $6,382.83 / $6,493.40
| Facility | | $5,844.87 | $6,382.83 | $6,493.40 |
- 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
- $5,702.62 / $7,372.40 / $11,552.46
| Facility | | $5,702.62 | $7,372.40 | $11,552.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,990.36 / $9,316.14 / $12,294.79
| Facility | | $6,990.36 | $9,316.14 | $12,294.79 |