- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,405.14 / $7,751.07 / $9,546.08
| Facility | | $6,405.14 | $7,751.07 | $9,546.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,269.22 / $6,846.23 / $6,964.83
| Facility | | $6,269.22 | $6,846.23 | $6,964.83 |
- 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
- $6,116.63 / $7,907.65 / $12,391.18
| Facility | | $6,116.63 | $7,907.65 | $12,391.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,497.87 / $9,992.50 / $13,187.41
| Facility | | $7,497.87 | $9,992.50 | $13,187.41 |