- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,818.50 / $10,818.50 / $10,818.50
| Facility | | $10,818.50 | $10,818.50 | $10,818.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,315.68 / $8,608.82 / $8,608.82
| Facility | | $8,315.68 | $8,608.82 | $8,608.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,078.04 / $7,155.42 / $13,957.69
| Facility | | $5,078.04 | $7,155.42 | $13,957.69 |
- 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
- $5,078.04 / $7,155.42 / $13,139.81
| Facility | | $5,078.04 | $7,155.42 | $13,139.81 |