- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,994.87 / $10,885.00 / $13,405.80
| Facility | | $8,994.87 | $10,885.00 | $13,405.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,804.00 / $9,614.32 / $9,780.87
| Facility | | $8,804.00 | $9,614.32 | $9,780.87 |
- 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
- $8,589.73 / $11,104.89 / $17,401.21
| Facility | | $8,589.73 | $11,104.89 | $17,401.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,529.43 / $14,032.69 / $18,519.37
| Facility | | $10,529.43 | $14,032.69 | $18,519.37 |