- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,419.07 / $10,188.20 / $12,547.60
| Facility | | $8,419.07 | $10,188.20 | $12,547.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,240.40 / $8,998.85 / $9,154.74
| Facility | | $8,240.40 | $8,998.85 | $9,154.74 |
- 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
- $8,039.84 / $10,393.99 / $16,287.25
| Facility | | $8,039.84 | $10,393.99 | $16,287.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,855.37 / $13,134.37 / $17,333.83
| Facility | | $9,855.37 | $13,134.37 | $17,333.83 |