- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,086.46 / $9,785.68 / $12,051.90
| Facility | | $8,086.46 | $9,785.68 | $12,051.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,914.85 / $8,643.33 / $8,793.06
| Facility | | $7,914.85 | $8,643.33 | $8,793.06 |
- 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
- $7,722.22 / $9,983.36 / $15,643.80
| Facility | | $7,722.22 | $9,983.36 | $15,643.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,466.02 / $12,615.48 / $16,649.03
| Facility | | $9,466.02 | $12,615.48 | $16,649.03 |