- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,921.36 / $8,375.76 / $10,315.40
| Facility | | $6,921.36 | $8,375.76 | $10,315.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,774.48 / $7,398.00 / $7,526.16
| Facility | | $6,774.48 | $7,398.00 | $7,526.16 |
- 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
- $6,609.60 / $8,544.95 / $13,389.84
| Facility | | $6,609.60 | $8,544.95 | $13,389.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,102.16 / $10,797.84 / $14,250.24
| Facility | | $8,102.16 | $10,797.84 | $14,250.24 |