- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,039.35 / $9,728.68 / $11,981.70
| Facility | | $8,039.35 | $9,728.68 | $11,981.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,868.75 / $8,592.98 / $8,741.84
| Facility | | $7,868.75 | $8,592.98 | $8,741.84 |
- 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
- $7,677.23 / $9,925.20 / $15,552.67
| Facility | | $7,677.23 | $9,925.20 | $15,552.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,677.23 / $10,813.00 / $14,672.88
| Facility | | $7,677.23 | $10,813.00 | $14,672.88 |