- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,094.64 / $7,375.32 / $9,083.32
| Facility | | $6,094.64 | $7,375.32 | $9,083.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,965.31 / $6,514.35 / $6,627.20
| Facility | | $5,965.31 | $6,514.35 | $6,627.20 |
- 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
- $5,820.12 / $7,524.31 / $11,790.50
| Facility | | $5,820.12 | $7,524.31 | $11,790.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,134.40 / $9,508.10 / $12,548.13
| Facility | | $7,134.40 | $9,508.10 | $12,548.13 |