- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,231.90 / $11,231.90 / $11,231.90
| Facility | | $11,231.90 | $11,231.90 | $11,231.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,633.43 / $8,937.77 / $8,937.77
| Facility | | $8,633.43 | $8,937.77 | $8,937.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,272.08 / $7,428.84 / $13,664.11
| Facility | | $5,272.08 | $7,428.84 | $13,664.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.00 / $950.00 / $950.00
| Facility | | $950.00 | $950.00 | $950.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,272.08 / $7,428.84 / $13,641.91
| Facility | | $5,272.08 | $7,428.84 | $13,641.91 |