- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,828.10 / $11,828.10 / $11,828.10
| Facility | | $11,828.10 | $11,828.10 | $11,828.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,091.69 / $9,412.19 / $9,412.19
| Facility | | $9,091.69 | $9,412.19 | $9,412.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,551.92 / $7,823.16 / $14,690.50
| Facility | | $5,551.92 | $7,823.16 | $14,690.50 |
- 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
- $5,551.92 / $7,823.16 / $14,366.01
| Facility | | $5,551.92 | $7,823.16 | $14,366.01 |