- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,165.28 / $9,881.07 / $12,169.40
| Facility | | $8,165.28 | $9,881.07 | $12,169.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,992.00 / $8,727.59 / $8,878.78
| Facility | | $7,992.00 | $8,727.59 | $8,878.78 |
- 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
- $7,797.49 / $10,080.68 / $15,796.29
| Facility | | $7,797.49 | $10,080.68 | $15,796.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,558.29 / $12,738.45 / $16,811.32
| Facility | | $9,558.29 | $12,738.45 | $16,811.32 |