- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,217.19 / $9,943.89 / $12,246.70
| Facility | | $8,217.19 | $9,943.89 | $12,246.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,042.81 / $8,783.07 / $8,935.21
| Facility | | $8,042.81 | $8,783.07 | $8,935.21 |
- 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
- $7,847.06 / $10,144.77 / $15,896.72
| Facility | | $7,847.06 | $10,144.77 | $15,896.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,619.06 / $12,819.44 / $16,918.20
| Facility | | $9,619.06 | $12,819.44 | $16,918.20 |