- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,257.20 / $11,257.20 / $11,257.20
| Facility | | $11,257.20 | $11,257.20 | $11,257.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,652.87 / $8,957.91 / $8,957.91
| Facility | | $8,652.87 | $8,957.91 | $8,957.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,283.96 / $7,445.58 / $12,796.55
| Facility | | $5,283.96 | $7,445.58 | $12,796.55 |
- 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
- $5,283.96 / $7,445.58 / $13,672.65
| Facility | | $5,283.96 | $7,445.58 | $13,672.65 |