- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,382.40 / $11,382.40 / $11,382.40
| Facility | | $11,382.40 | $11,382.40 | $11,382.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,749.08 / $9,057.50 / $9,057.50
| Facility | | $8,749.08 | $9,057.50 | $9,057.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,342.70 / $7,528.35 / $13,706.80
| Facility | | $5,342.70 | $7,528.35 | $13,706.80 |
- 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
- $5,342.70 / $7,528.35 / $13,824.64
| Facility | | $5,342.70 | $7,528.35 | $13,824.64 |