- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,798.07 / $9,436.69 / $11,622.10
| Facility | | $7,798.07 | $9,436.69 | $11,622.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,632.58 / $8,335.08 / $8,479.46
| Facility | | $7,632.58 | $8,335.08 | $8,479.46 |
- 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
- $7,446.82 / $9,627.32 / $15,085.89
| Facility | | $7,446.82 | $9,627.32 | $15,085.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,128.43 / $12,165.57 / $16,055.27
| Facility | | $9,128.43 | $12,165.57 | $16,055.27 |