- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,420.87 / $9,420.87 / $9,420.87
| Facility | | $9,420.87 | $9,420.87 | $9,420.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,241.36 / $7,496.63 / $7,496.63
| Facility | | $7,241.36 | $7,496.63 | $7,496.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,422.00 / $6,231.00 / $11,896.53
| Facility | | $4,422.00 | $6,231.00 | $11,896.53 |
- 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
- $4,422.00 / $6,231.00 / $11,442.26
| Facility | | $4,422.00 | $6,231.00 | $11,442.26 |