- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,575.00 / $11,575.00 / $11,575.00
| Facility | | $11,575.00 | $11,575.00 | $11,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,897.15 / $9,210.78 / $9,210.78
| Facility | | $8,897.15 | $9,210.78 | $9,210.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,433.12 / $7,655.76 / $14,640.97
| Facility | | $5,433.12 | $7,655.76 | $14,640.97 |
- 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
- $5,433.12 / $7,655.76 / $14,058.61
| Facility | | $5,433.12 | $7,655.76 | $14,058.61 |