- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,320.79 / $10,320.79 / $10,320.79
| Facility | | $10,320.79 | $10,320.79 | $10,320.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,933.07 / $8,212.73 / $8,212.73
| Facility | | $7,933.07 | $8,212.73 | $8,212.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,844.39 / $6,826.20 / $12,945.12
| Facility | | $4,844.39 | $6,826.20 | $12,945.12 |
- 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
- $4,844.39 / $6,826.20 / $12,535.25
| Facility | | $4,844.39 | $6,826.20 | $12,535.25 |