- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,034.08 / $7,302.03 / $8,993.06
| Facility | | $6,034.08 | $7,302.03 | $8,993.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,906.03 / $6,449.62 / $6,561.35
| Facility | | $5,906.03 | $6,449.62 | $6,561.35 |
- 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
- $5,762.29 / $7,449.54 / $11,673.34
| Facility | | $5,762.29 | $7,449.54 | $11,673.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,063.51 / $9,413.62 / $12,423.44
| Facility | | $7,063.51 | $9,413.62 | $12,423.44 |