- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,979.75 / $9,656.54 / $11,892.80
| Facility | | $7,979.75 | $9,656.54 | $11,892.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,810.41 / $8,529.28 / $8,677.04
| Facility | | $7,810.41 | $8,529.28 | $8,677.04 |
- 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
- $7,620.32 / $9,851.62 / $15,437.37
| Facility | | $7,620.32 | $9,851.62 | $15,437.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,341.12 / $12,449.01 / $16,429.34
| Facility | | $9,341.12 | $12,449.01 | $16,429.34 |