- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,060.04 / $7,333.44 / $9,031.74
| Facility | | $6,060.04 | $7,333.44 | $9,031.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,931.43 / $6,477.36 / $6,589.57
| Facility | | $5,931.43 | $6,477.36 | $6,589.57 |
- 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
- $5,787.07 / $7,481.59 / $11,723.55
| Facility | | $5,787.07 | $7,481.59 | $11,723.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,093.89 / $9,454.11 / $12,476.88
| Facility | | $7,093.89 | $9,454.11 | $12,476.88 |