- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,355.70 / $11,355.70 / $11,355.70
| Facility | | $11,355.70 | $11,355.70 | $11,355.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,728.54 / $9,036.24 / $9,036.24
| Facility | | $8,728.54 | $9,036.24 | $9,036.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,330.16 / $7,510.68 / $13,848.55
| Facility | | $5,330.16 | $7,510.68 | $13,848.55 |
- 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
- $5,330.16 / $7,510.68 / $13,792.19
| Facility | | $5,330.16 | $7,510.68 | $13,792.19 |