- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,344.83 / $6,467.95 / $7,965.81
| Facility | | $5,344.83 | $6,467.95 | $7,965.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,231.39 / $5,712.90 / $5,811.87
| Facility | | $5,231.39 | $5,712.90 | $5,811.87 |
- 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
- $5,104.08 / $6,598.61 / $10,339.93
| Facility | | $5,104.08 | $6,598.61 | $10,339.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,256.67 / $8,338.33 / $11,004.35
| Facility | | $6,256.67 | $8,338.33 | $11,004.35 |