- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,229.10 / $11,229.10 / $11,229.10
| Facility | | $11,229.10 | $11,229.10 | $11,229.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,631.27 / $8,935.54 / $8,935.54
| Facility | | $8,631.27 | $8,935.54 | $8,935.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,270.76 / $7,426.98 / $13,717.05
| Facility | | $5,270.76 | $7,426.98 | $13,717.05 |
- 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
- $5,270.76 / $7,426.98 / $13,638.49
| Facility | | $5,270.76 | $7,426.98 | $13,638.49 |