- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,992.50 / $8,461.84 / $10,421.50
| Facility | | $6,992.50 | $8,461.84 | $10,421.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,844.11 / $7,474.04 / $7,603.51
| Facility | | $6,844.11 | $7,474.04 | $7,603.51 |
- 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
- $6,677.53 / $8,632.78 / $13,527.46
| Facility | | $6,677.53 | $8,632.78 | $13,527.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,677.53 / $9,405.00 / $12,762.23
| Facility | | $6,677.53 | $9,405.00 | $12,762.23 |