- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,609.40 / $10,418.50 / $12,831.30
| Facility | | $8,609.40 | $10,418.50 | $12,831.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,426.70 / $9,202.29 / $9,361.70
| Facility | | $8,426.70 | $9,202.29 | $9,361.70 |
- 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
- $8,221.61 / $10,628.98 / $16,655.47
| Facility | | $8,221.61 | $10,628.98 | $16,655.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,078.19 / $13,431.31 / $17,725.72
| Facility | | $10,078.19 | $13,431.31 | $17,725.72 |