- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,119.70 / $10,119.70 / $10,119.70
| Facility | | $10,119.70 | $10,119.70 | $10,119.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,778.52 / $8,052.72 / $8,052.72
| Facility | | $7,778.52 | $8,052.72 | $8,052.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,750.02 / $6,693.21 / $12,183.45
| Facility | | $4,750.02 | $6,693.21 | $12,183.45 |
- 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
- $4,750.02 / $6,693.21 / $12,291.04
| Facility | | $4,750.02 | $6,693.21 | $12,291.04 |