- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,591.01 / $9,591.01 / $9,591.01
| Facility | | $9,591.01 | $9,591.01 | $9,591.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,372.14 / $7,632.02 / $7,632.02
| Facility | | $7,372.14 | $7,632.02 | $7,632.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,501.85 / $6,343.53 / $11,659.15
| Facility | | $4,501.85 | $6,343.53 | $11,659.15 |
- 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
- $4,501.85 / $6,343.53 / $11,648.90
| Facility | | $4,501.85 | $6,343.53 | $11,648.90 |