- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,838.48 / $9,838.48 / $9,838.48
| Facility | | $9,838.48 | $9,838.48 | $9,838.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,562.36 / $7,828.94 / $7,828.94
| Facility | | $7,562.36 | $7,828.94 | $7,828.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,618.02 / $6,507.21 / $12,000.71
| Facility | | $4,618.02 | $6,507.21 | $12,000.71 |
- 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
- $4,618.02 / $6,507.21 / $11,949.48
| Facility | | $4,618.02 | $6,507.21 | $11,949.48 |