- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,533.45 / $10,326.60 / $12,718.10
| Facility | | $8,533.45 | $10,326.60 | $12,718.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,352.37 / $9,121.12 / $9,279.12
| Facility | | $8,352.37 | $9,121.12 | $9,279.12 |
- 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
- $8,149.09 / $10,535.22 / $16,508.56
| Facility | | $8,149.09 | $10,535.22 | $16,508.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,989.29 / $13,312.84 / $17,569.36
| Facility | | $9,989.29 | $13,312.84 | $17,569.36 |