- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,103.76 / $9,806.62 / $12,077.70
| Facility | | $8,103.76 | $9,806.62 | $12,077.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,931.79 / $8,661.83 / $8,811.87
| Facility | | $7,931.79 | $8,661.83 | $8,811.87 |
- 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
- $7,738.74 / $10,004.71 / $15,677.27
| Facility | | $7,738.74 | $10,004.71 | $15,677.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,486.28 / $12,642.47 / $16,684.66
| Facility | | $9,486.28 | $12,642.47 | $16,684.66 |