- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,654.12 / $8,052.36 / $9,917.15
| Facility | | $6,654.12 | $8,052.36 | $9,917.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,512.91 / $7,112.36 / $7,235.57
| Facility | | $6,512.91 | $7,112.36 | $7,235.57 |
- 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
- $6,354.40 / $8,215.03 / $12,872.84
| Facility | | $6,354.40 | $8,215.03 | $12,872.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,789.33 / $10,380.92 / $13,700.02
| Facility | | $7,789.33 | $10,380.92 | $13,700.02 |