- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,128.10 / $10,128.10 / $10,128.10
| Facility | | $10,128.10 | $10,128.10 | $10,128.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,785.00 / $8,059.44 / $8,059.44
| Facility | | $7,785.00 | $8,059.44 | $8,059.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,753.97 / $6,698.79 / $11,467.88
| Facility | | $4,753.97 | $6,698.79 | $11,467.88 |
- 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
- $4,753.97 / $6,698.79 / $12,301.28
| Facility | | $4,753.97 | $6,698.79 | $12,301.28 |