- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,087.42 / $9,786.84 / $12,053.30
| Facility | | $8,087.42 | $9,786.84 | $12,053.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,915.79 / $8,644.36 / $8,794.11
| Facility | | $7,915.79 | $8,644.36 | $8,794.11 |
- 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
- $7,723.13 / $9,984.54 / $15,645.66
| Facility | | $7,723.13 | $9,984.54 | $15,645.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,467.15 / $12,616.98 / $16,651.00
| Facility | | $9,467.15 | $12,616.98 | $16,651.00 |