- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,459.94 / $7,817.38 / $9,627.74
| Facility | | $6,459.94 | $7,817.38 | $9,627.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,322.85 / $6,904.80 / $7,024.42
| Facility | | $6,322.85 | $6,904.80 | $7,024.42 |
- 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
- $6,168.96 / $7,975.30 / $12,497.18
| Facility | | $6,168.96 | $7,975.30 | $12,497.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,562.02 / $10,077.98 / $13,300.22
| Facility | | $7,562.02 | $10,077.98 | $13,300.22 |