- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,733.02 / $9,733.02 / $9,733.02
| Facility | | $9,733.02 | $9,733.02 | $9,733.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,481.30 / $7,745.03 / $7,745.03
| Facility | | $7,481.30 | $7,745.03 | $7,745.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,568.52 / $6,437.46 / $12,557.20
| Facility | | $4,568.52 | $6,437.46 | $12,557.20 |
- 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
- $4,568.52 / $6,437.46 / $11,821.39
| Facility | | $4,568.52 | $6,437.46 | $11,821.39 |