- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,105.40 / $11,105.40 / $11,105.40
| Facility | | $11,105.40 | $11,105.40 | $11,105.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,536.16 / $8,837.07 / $8,837.07
| Facility | | $8,536.16 | $8,837.07 | $8,837.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,212.68 / $7,345.14 / $13,689.72
| Facility | | $5,212.68 | $7,345.14 | $13,689.72 |
- 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
- $5,212.68 / $7,345.14 / $13,488.20
| Facility | | $5,212.68 | $7,345.14 | $13,488.20 |