- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,623.36 / $8,015.14 / $9,871.29
| Facility | | $6,623.36 | $8,015.14 | $9,871.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,482.80 / $7,079.48 / $7,202.12
| Facility | | $6,482.80 | $7,079.48 | $7,202.12 |
- 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
- $6,325.02 / $8,177.05 / $12,813.33
| Facility | | $6,325.02 | $8,177.05 | $12,813.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,753.32 / $10,332.93 / $13,636.69
| Facility | | $7,753.32 | $10,332.93 | $13,636.69 |