- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,055.94 / $8,538.62 / $10,516.00
| Facility | | $7,055.94 | $8,538.62 | $10,516.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,906.21 / $7,541.85 / $7,672.50
| Facility | | $6,906.21 | $7,541.85 | $7,672.50 |
- 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
- $6,738.12 / $8,711.11 / $13,650.20
| Facility | | $6,738.12 | $8,711.11 | $13,650.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,259.70 / $11,007.80 / $14,527.33
| Facility | | $8,259.70 | $11,007.80 | $14,527.33 |