- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,826.66 / $10,681.40 / $13,155.10
| Facility | | $8,826.66 | $10,681.40 | $13,155.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.34 / $9,434.51 / $9,597.94
| Facility | | $8,639.34 | $9,434.51 | $9,597.94 |
- 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
- $8,429.08 / $10,897.20 / $17,075.77
| Facility | | $8,429.08 | $10,897.20 | $17,075.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,332.50 / $13,770.25 / $18,173.00
| Facility | | $10,332.50 | $13,770.25 | $18,173.00 |