- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,942.30 / $10,942.30 / $10,942.30
| Facility | | $10,942.30 | $10,942.30 | $10,942.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,410.79 / $8,707.28 / $8,707.28
| Facility | | $8,410.79 | $8,707.28 | $8,707.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,136.12 / $7,237.26 / $13,344.75
| Facility | | $5,136.12 | $7,237.26 | $13,344.75 |
- 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
- $5,136.12 / $7,237.26 / $13,290.10
| Facility | | $5,136.12 | $7,237.26 | $13,290.10 |