- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,096.32 / $8,587.48 / $10,576.20
| Facility | | $7,096.32 | $8,587.48 | $10,576.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,945.72 / $7,585.01 / $7,716.40
| Facility | | $6,945.72 | $7,585.01 | $7,716.40 |
- 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
- $6,776.68 / $8,760.95 / $13,728.31
| Facility | | $6,776.68 | $8,760.95 | $13,728.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,306.95 / $11,070.79 / $14,610.45
| Facility | | $8,306.95 | $11,070.79 | $14,610.45 |