- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,070.50 / $10,070.50 / $10,070.50
| Facility | | $10,070.50 | $10,070.50 | $10,070.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,740.69 / $8,013.56 / $8,013.56
| Facility | | $7,740.69 | $8,013.56 | $8,013.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,726.92 / $6,660.66 / $11,961.43
| Facility | | $4,726.92 | $6,660.66 | $11,961.43 |
- 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
- $4,726.92 / $6,660.66 / $12,231.26
| Facility | | $4,726.92 | $6,660.66 | $12,231.26 |