- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,962.00 / $10,962.00 / $10,962.00
| Facility | | $10,962.00 | $10,962.00 | $10,962.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,425.92 / $8,722.94 / $8,722.94
| Facility | | $8,425.92 | $8,722.94 | $8,722.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,145.35 / $7,250.28 / $13,325.96
| Facility | | $5,145.35 | $7,250.28 | $13,325.96 |
- 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
- $5,145.35 / $7,250.28 / $13,314.01
| Facility | | $5,145.35 | $7,250.28 | $13,314.01 |