- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,962.21 / $9,962.21 / $9,962.21
| Facility | | $9,962.21 | $9,962.21 | $9,962.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,657.47 / $7,927.41 / $7,927.41
| Facility | | $7,657.47 | $7,927.41 | $7,927.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,676.10 / $6,589.05 / $11,264.65
| Facility | | $4,676.10 | $6,589.05 | $11,264.65 |
- 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
- $4,676.10 / $6,589.05 / $12,099.76
| Facility | | $4,676.10 | $6,589.05 | $12,099.76 |