- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,228.00 / $10,228.00 / $10,228.00
| Facility | | $10,228.00 | $10,228.00 | $10,228.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,861.74 / $8,138.88 / $8,138.88
| Facility | | $7,861.74 | $8,138.88 | $8,138.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,800.84 / $6,764.82 / $12,388.38
| Facility | | $4,800.84 | $6,764.82 | $12,388.38 |
- 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
- $5,319.48 / $7,604.97 / $12,447.27
| Facility | | $5,319.48 | $7,604.97 | $12,447.27 |