- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,849.26 / $8,288.51 / $10,208.00
| Facility | | $6,849.26 | $8,288.51 | $10,208.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,703.91 / $7,320.94 / $7,447.76
| Facility | | $6,703.91 | $7,320.94 | $7,447.76 |
- 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
- $6,540.75 / $8,455.95 / $13,250.36
| Facility | | $6,540.75 | $8,455.95 | $13,250.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,017.76 / $10,685.36 / $14,101.80
| Facility | | $8,017.76 | $10,685.36 | $14,101.80 |