- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,726.22 / $8,139.61 / $10,024.60
| Facility | | $6,726.22 | $8,139.61 | $10,024.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,583.48 / $7,189.42 / $7,313.96
| Facility | | $6,583.48 | $7,189.42 | $7,313.96 |
- 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
- $6,423.25 / $8,304.04 / $13,012.32
| Facility | | $6,423.25 | $8,304.04 | $13,012.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,873.72 / $10,493.40 / $13,848.46
| Facility | | $7,873.72 | $10,493.40 | $13,848.46 |