- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,835.31 / $10,691.90 / $13,167.90
| Facility | | $8,835.31 | $10,691.90 | $13,167.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,647.81 / $9,443.75 / $9,607.35
| Facility | | $8,647.81 | $9,443.75 | $9,607.35 |
- 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
- $8,437.34 / $10,907.88 / $17,092.50
| Facility | | $8,437.34 | $10,907.88 | $17,092.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,342.62 / $13,783.74 / $18,190.83
| Facility | | $10,342.62 | $13,783.74 | $18,190.83 |