- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,027.16 / $9,027.16 / $9,027.16
| Facility | | $9,027.16 | $9,027.16 | $9,027.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,938.74 / $7,183.34 / $7,183.34
| Facility | | $6,938.74 | $7,183.34 | $7,183.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,237.20 / $5,970.60 / $11,052.88
| Facility | | $4,237.20 | $5,970.60 | $11,052.88 |
- 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
- $4,237.20 / $5,970.60 / $10,964.08
| Facility | | $4,237.20 | $5,970.60 | $10,964.08 |