- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,706.27 / $8,638.58 / $10,802.60
| Facility | | $4,706.27 | $8,638.58 | $10,802.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.00 / $7,747.35 / $7,881.56
| Facility | | $3,548.00 | $7,747.35 | $7,881.56 |
- 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 / $8,573.73 / $14,022.14
| Facility | | $3,823.00 | $8,573.73 | $14,022.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $8,937.16 / $14,022.14
| Facility | | $3,800.00 | $8,937.16 | $14,022.14 |