- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,075.42 / $7,352.06 / $9,054.66
| Facility | | $6,075.42 | $7,352.06 | $9,054.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,946.49 / $6,493.80 / $6,606.30
| Facility | | $5,946.49 | $6,493.80 | $6,606.30 |
- 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
- $5,801.76 / $7,500.58 / $11,753.30
| Facility | | $5,801.76 | $7,500.58 | $11,753.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,111.90 / $9,478.10 / $12,508.54
| Facility | | $7,111.90 | $9,478.10 | $12,508.54 |