- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,334.60 / $11,334.60 / $11,334.60
| Facility | | $11,334.60 | $11,334.60 | $11,334.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,712.33 / $9,019.45 / $9,019.45
| Facility | | $8,712.33 | $9,019.45 | $9,019.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,320.26 / $7,496.73 / $13,901.49
| Facility | | $5,320.26 | $7,496.73 | $13,901.49 |
- 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
- $5,320.26 / $7,496.73 / $13,766.58
| Facility | | $5,320.26 | $7,496.73 | $13,766.58 |