- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,853.40 / $11,853.40 / $11,853.40
| Facility | | $11,853.40 | $11,853.40 | $11,853.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,111.14 / $9,432.33 / $9,432.33
| Facility | | $9,111.14 | $9,432.33 | $9,432.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,563.80 / $7,839.90 / $14,671.71
| Facility | | $5,563.80 | $7,839.90 | $14,671.71 |
- 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
- $5,563.80 / $7,839.90 / $14,396.75
| Facility | | $5,563.80 | $7,839.90 | $14,396.75 |