- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,632.70 / $11,632.70 / $11,632.70
| Facility | | $11,632.70 | $11,632.70 | $11,632.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,941.45 / $9,256.66 / $9,256.66
| Facility | | $8,941.45 | $9,256.66 | $9,256.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,460.18 / $7,693.89 / $13,616.29
| Facility | | $5,460.18 | $7,693.89 | $13,616.29 |
- 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
- $5,460.18 / $7,693.89 / $14,128.63
| Facility | | $5,460.18 | $7,693.89 | $14,128.63 |