- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,484.22 / $6,636.63 / $8,173.55
| Facility | | $5,484.22 | $6,636.63 | $8,173.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,367.83 / $5,861.89 / $5,963.44
| Facility | | $5,367.83 | $5,861.89 | $5,963.44 |
- 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
- $5,237.18 / $6,770.69 / $10,609.59
| Facility | | $5,237.18 | $6,770.69 | $10,609.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,419.84 / $8,555.79 / $11,291.34
| Facility | | $6,419.84 | $8,555.79 | $11,291.34 |