- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,874.26 / $8,318.76 / $10,245.20
| Facility | | $6,874.26 | $8,318.76 | $10,245.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,728.38 / $7,347.65 / $7,474.94
| Facility | | $6,728.38 | $7,347.65 | $7,474.94 |
- 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
- $6,564.62 / $8,486.81 / $13,298.71
| Facility | | $6,564.62 | $8,486.81 | $13,298.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,047.02 / $10,724.35 / $14,153.26
| Facility | | $8,047.02 | $10,724.35 | $14,153.26 |