- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,672.00 / $11,672.00 / $11,672.00
| Facility | | $11,672.00 | $11,672.00 | $11,672.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,971.71 / $9,287.99 / $9,287.99
| Facility | | $8,971.71 | $9,287.99 | $9,287.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,478.66 / $7,719.93 / $14,253.30
| Facility | | $5,478.66 | $7,719.93 | $14,253.30 |
- 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
- $5,478.66 / $7,719.93 / $14,176.45
| Facility | | $5,478.66 | $7,719.93 | $14,176.45 |