- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,932.65 / $9,599.54 / $11,822.60
| Facility | | $7,932.65 | $9,599.54 | $11,822.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,764.31 / $8,478.93 / $8,625.82
| Facility | | $7,764.31 | $8,478.93 | $8,625.82 |
- 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
- $7,575.34 / $9,793.46 / $15,346.24
| Facility | | $7,575.34 | $9,793.46 | $15,346.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,575.34 / $10,650.86 / $15,346.24
| Facility | | $7,575.34 | $10,650.86 | $15,346.24 |