- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,842.04 / $10,700.00 / $13,178.00
| Facility | | $8,842.04 | $10,700.00 | $13,178.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,654.40 / $9,450.95 / $9,614.67
| Facility | | $8,654.40 | $9,450.95 | $9,614.67 |
- 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
- $8,443.76 / $10,916.19 / $17,105.52
| Facility | | $8,443.76 | $10,916.19 | $17,105.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,350.51 / $13,794.24 / $18,204.68
| Facility | | $10,350.51 | $13,794.24 | $18,204.68 |