- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,161.44 / $9,876.42 / $12,163.60
| Facility | | $8,161.44 | $9,876.42 | $12,163.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,988.24 / $8,723.48 / $8,874.60
| Facility | | $7,988.24 | $8,723.48 | $8,874.60 |
- 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
- $7,793.82 / $10,075.93 / $15,788.85
| Facility | | $7,793.82 | $10,075.93 | $15,788.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,553.79 / $12,732.45 / $16,803.41
| Facility | | $9,553.79 | $12,732.45 | $16,803.41 |