- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,688.03 / $9,688.03 / $9,688.03
| Facility | | $9,688.03 | $9,688.03 | $9,688.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,446.71 / $7,709.22 / $7,709.22
| Facility | | $7,446.71 | $7,709.22 | $7,709.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,547.39 / $6,407.70 / $11,814.56
| Facility | | $4,547.39 | $6,407.70 | $11,814.56 |
- 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
- $4,547.39 / $6,407.70 / $11,766.74
| Facility | | $4,547.39 | $6,407.70 | $11,766.74 |