- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,937.20 / $10,815.20 / $13,319.80
| Facility | | $8,937.20 | $10,815.20 | $13,319.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,747.54 / $9,552.67 / $9,718.15
| Facility | | $8,747.54 | $9,552.67 | $9,718.15 |
- 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
- $8,534.65 / $11,033.68 / $17,289.63
| Facility | | $8,534.65 | $11,033.68 | $17,289.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,461.91 / $13,942.71 / $18,400.62
| Facility | | $10,461.91 | $13,942.71 | $18,400.62 |