- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,055.00 / $10,055.00 / $10,055.00
| Facility | | $10,055.00 | $10,055.00 | $10,055.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,728.80 / $8,001.25 / $8,001.25
| Facility | | $7,728.80 | $8,001.25 | $8,001.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,719.66 / $6,650.43 / $11,563.51
| Facility | | $4,719.66 | $6,650.43 | $11,563.51 |
- 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
- $4,719.66 / $6,650.43 / $12,212.48
| Facility | | $4,719.66 | $6,650.43 | $12,212.48 |