- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,747.36 / $8,165.20 / $10,056.10
| Facility | | $6,747.36 | $8,165.20 | $10,056.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,604.18 / $7,212.02 / $7,336.96
| Facility | | $6,604.18 | $7,212.02 | $7,336.96 |
- 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
- $6,443.44 / $8,330.15 / $13,053.23
| Facility | | $6,443.44 | $8,330.15 | $13,053.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,898.48 / $10,526.39 / $13,892.00
| Facility | | $7,898.48 | $10,526.39 | $13,892.00 |