- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,072.28 / $8,558.40 / $10,540.40
| Facility | | $7,072.28 | $8,558.40 | $10,540.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,922.20 / $7,559.32 / $7,690.27
| Facility | | $6,922.20 | $7,559.32 | $7,690.27 |
- 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
- $6,753.73 / $8,731.29 / $13,681.81
| Facility | | $6,753.73 | $8,731.29 | $13,681.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,278.83 / $11,033.29 / $14,560.97
| Facility | | $8,278.83 | $11,033.29 | $14,560.97 |