- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,293.63 / $7,616.13 / $9,379.89
| Facility | | $6,293.63 | $7,616.13 | $9,379.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,160.07 / $6,727.04 / $6,843.58
| Facility | | $6,160.07 | $6,727.04 | $6,843.58 |
- 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
- $6,010.15 / $7,769.98 / $12,175.46
| Facility | | $6,010.15 | $7,769.98 | $12,175.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,367.34 / $9,818.54 / $12,957.82
| Facility | | $7,367.34 | $9,818.54 | $12,957.82 |