- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,593.00 / $12,593.00 / $12,593.00
| Facility | | $12,593.00 | $12,593.00 | $12,593.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,679.64 / $10,020.87 / $10,020.87
| Facility | | $9,679.64 | $10,020.87 | $10,020.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,910.96 / $8,329.08 / $15,452.17
| Facility | | $5,910.96 | $8,329.08 | $15,452.17 |
- 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
- $5,910.96 / $8,329.08 / $15,295.06
| Facility | | $5,910.96 | $8,329.08 | $15,295.06 |