- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,869.42 / $9,869.42 / $9,869.42
| Facility | | $9,869.42 | $9,869.42 | $9,869.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,586.14 / $7,853.56 / $7,853.56
| Facility | | $7,586.14 | $7,853.56 | $7,853.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,632.54 / $6,527.67 / $11,925.57
| Facility | | $4,632.54 | $6,527.67 | $11,925.57 |
- 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
- $4,632.54 / $6,527.67 / $11,987.05
| Facility | | $4,632.54 | $6,527.67 | $11,987.05 |