- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.24 / $7,627.76 / $9,394.20
| Facility | | $6,303.24 | $7,627.76 | $9,394.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,169.48 / $6,737.32 / $6,854.03
| Facility | | $6,169.48 | $6,737.32 | $6,854.03 |
- 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
- $6,019.33 / $7,781.85 / $12,194.05
| Facility | | $6,019.33 | $7,781.85 | $12,194.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,378.59 / $9,833.53 / $12,977.61
| Facility | | $7,378.59 | $9,833.53 | $12,977.61 |