- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,379.79 / $10,379.79 / $10,379.79
| Facility | | $10,379.79 | $10,379.79 | $10,379.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,978.47 / $8,259.71 / $8,259.71
| Facility | | $7,978.47 | $8,259.71 | $8,259.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,872.12 / $6,865.26 / $12,154.41
| Facility | | $4,872.12 | $6,865.26 | $12,154.41 |
- 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
- $4,872.12 / $6,865.26 / $12,606.98
| Facility | | $4,872.12 | $6,865.26 | $12,606.98 |