- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,713.21 / $10,544.20 / $12,986.00
| Facility | | $8,713.21 | $10,544.20 | $12,986.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,528.32 / $9,313.26 / $9,474.60
| Facility | | $8,528.32 | $9,313.26 | $9,474.60 |
- 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
- $8,320.75 / $10,757.16 / $16,856.32
| Facility | | $8,320.75 | $10,757.16 | $16,856.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,199.71 / $13,593.28 / $17,939.47
| Facility | | $10,199.71 | $13,593.28 | $17,939.47 |