- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,829.50 / $11,829.50 / $11,829.50
| Facility | | $11,829.50 | $11,829.50 | $11,829.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,092.77 / $9,413.31 / $9,413.31
| Facility | | $9,092.77 | $9,413.31 | $9,413.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,552.58 / $7,824.09 / $15,262.02
| Facility | | $5,552.58 | $7,824.09 | $15,262.02 |
- 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
- $5,552.58 / $7,824.09 / $14,367.72
| Facility | | $5,552.58 | $7,824.09 | $14,367.72 |