- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,406.30 / $11,406.30 / $11,406.30
| Facility | | $11,406.30 | $11,406.30 | $11,406.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,767.45 / $9,076.52 / $9,076.52
| Facility | | $8,767.45 | $9,076.52 | $9,076.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,353.92 / $7,544.16 / $13,954.43
| Facility | | $5,353.92 | $7,544.16 | $13,954.43 |
- 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
- $5,353.92 / $7,544.16 / $13,853.67
| Facility | | $5,353.92 | $7,544.16 | $13,853.67 |