- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,952.83 / $9,623.98 / $11,852.70
| Facility | | $7,952.83 | $9,623.98 | $11,852.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,784.07 / $8,500.51 / $8,647.77
| Facility | | $7,784.07 | $8,500.51 | $8,647.77 |
- 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
- $7,594.61 / $9,818.40 / $15,385.30
| Facility | | $7,594.61 | $9,818.40 | $15,385.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,309.61 / $12,407.02 / $16,373.92
| Facility | | $9,309.61 | $12,407.02 | $16,373.92 |