- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,014.61 / $8,488.60 / $10,454.40
| Facility | | $7,014.61 | $8,488.60 | $10,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,865.75 / $7,497.67 / $7,627.55
| Facility | | $6,865.75 | $7,497.67 | $7,627.55 |
- 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
- $6,698.65 / $8,660.08 / $13,570.23
| Facility | | $6,698.65 | $8,660.08 | $13,570.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,211.31 / $10,943.31 / $14,442.22
| Facility | | $8,211.31 | $10,943.31 | $14,442.22 |