- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,386.68 / $7,724.31 / $9,659.26
| Facility | | $4,386.68 | $7,724.31 | $9,659.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,898.00 / $6,927.41 / $7,047.41
| Facility | | $2,898.00 | $6,927.41 | $7,047.41 |
- 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 / $7,666.33 / $12,538.10
| Facility | | $3,823.00 | $7,666.33 | $12,538.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $7,991.29 / $12,538.10
| Facility | | $3,800.00 | $7,991.29 | $12,538.10 |