- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,471.47 / $7,831.34 / $9,644.94
| Facility | | $6,471.47 | $7,831.34 | $9,644.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,334.14 / $6,917.13 / $7,036.96
| Facility | | $6,334.14 | $6,917.13 | $7,036.96 |
- 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
- $6,179.98 / $7,989.54 / $12,519.50
| Facility | | $6,179.98 | $7,989.54 | $12,519.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,575.52 / $10,095.98 / $13,323.97
| Facility | | $7,575.52 | $10,095.98 | $13,323.97 |