- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,514.48 / $9,093.52 / $11,199.40
| Facility | | $7,514.48 | $9,093.52 | $11,199.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,355.02 / $8,031.97 / $8,171.11
| Facility | | $7,355.02 | $8,031.97 | $8,171.11 |
- 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
- $7,176.01 / $9,277.21 / $14,537.27
| Facility | | $7,176.01 | $9,277.21 | $14,537.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,176.01 / $10,107.00 / $13,714.93
| Facility | | $7,176.01 | $10,107.00 | $13,714.93 |