- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,553.90 / $9,141.20 / $11,258.20
| Facility | | $7,553.90 | $9,141.20 | $11,258.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,393.59 / $8,074.10 / $8,213.96
| Facility | | $7,393.59 | $8,074.10 | $8,213.96 |
- 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
- $7,213.64 / $9,325.87 / $14,613.52
| Facility | | $7,213.64 | $9,325.87 | $14,613.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,842.61 / $11,784.64 / $15,552.55
| Facility | | $8,842.61 | $11,784.64 | $15,552.55 |