- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,579.76 / $9,579.76 / $9,579.76
| Facility | | $9,579.76 | $9,579.76 | $9,579.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,363.49 / $7,623.07 / $7,623.07
| Facility | | $7,363.49 | $7,623.07 | $7,623.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,496.58 / $6,336.09 / $11,447.38
| Facility | | $4,496.58 | $6,336.09 | $11,447.38 |
- 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
- $4,496.58 / $6,336.09 / $11,635.24
| Facility | | $4,496.58 | $6,336.09 | $11,635.24 |