- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,881.18 / $10,593.80 / $13,712.40
| Facility | | $4,881.18 | $10,593.80 | $13,712.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,792.00 / $9,834.20 / $10,004.57
| Facility | | $5,792.00 | $9,834.20 | $10,004.57 |
- 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
- $3,823.00 / $10,883.18 / $17,799.18
| Facility | | $3,823.00 | $10,883.18 | $17,799.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $11,344.51 / $17,799.18
| Facility | | $3,800.00 | $11,344.51 | $17,799.18 |