- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,371.95 / $10,131.20 / $12,477.40
| Facility | | $8,371.95 | $10,131.20 | $12,477.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,194.29 / $8,948.50 / $9,103.52
| Facility | | $8,194.29 | $8,948.50 | $9,103.52 |
- 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
- $7,994.86 / $10,335.84 / $16,196.13
| Facility | | $7,994.86 | $10,335.84 | $16,196.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,800.24 / $13,060.89 / $17,236.84
| Facility | | $9,800.24 | $13,060.89 | $17,236.84 |