- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,959.93 / $7,959.93 / $7,959.93
| Facility | | $7,959.93 | $7,959.93 | $7,959.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,118.41 / $6,334.09 / $6,334.09
| Facility | | $6,118.41 | $6,334.09 | $6,334.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,736.26 / $5,264.73 / $9,555.14
| Facility | | $3,736.26 | $5,264.73 | $9,555.14 |
- 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
- $3,736.26 / $5,264.73 / $9,667.86
| Facility | | $3,736.26 | $5,264.73 | $9,667.86 |