- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,781.72 / $9,416.91 / $11,597.70
| Facility | | $7,781.72 | $9,416.91 | $11,597.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,616.59 / $8,317.61 / $8,461.70
| Facility | | $7,616.59 | $8,317.61 | $8,461.70 |
- 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
- $7,431.21 / $9,607.15 / $15,054.27
| Facility | | $7,431.21 | $9,607.15 | $15,054.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,109.29 / $12,140.07 / $16,021.62
| Facility | | $9,109.29 | $12,140.07 | $16,021.62 |