- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,984.56 / $9,662.37 / $11,900.00
| Facility | | $7,984.56 | $9,662.37 | $11,900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,815.12 / $8,534.42 / $8,682.26
| Facility | | $7,815.12 | $8,534.42 | $8,682.26 |
- 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
- $7,624.91 / $9,857.56 / $15,446.67
| Facility | | $7,624.91 | $9,857.56 | $15,446.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,624.91 / $10,740.00 / $14,572.88
| Facility | | $7,624.91 | $10,740.00 | $14,572.88 |