- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,738.46 / $9,364.57 / $11,533.20
| Facility | | $7,738.46 | $9,364.57 | $11,533.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,574.25 / $8,271.37 / $8,414.67
| Facility | | $7,574.25 | $8,271.37 | $8,414.67 |
- 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
- $7,389.90 / $9,553.74 / $14,970.59
| Facility | | $7,389.90 | $9,553.74 | $14,970.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,058.67 / $12,072.59 / $15,932.56
| Facility | | $9,058.67 | $12,072.59 | $15,932.56 |