- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,974.30 / $11,974.30 / $11,974.30
| Facility | | $11,974.30 | $11,974.30 | $11,974.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,204.09 / $9,528.54 / $9,528.54
| Facility | | $9,204.09 | $9,528.54 | $9,528.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,620.56 / $7,919.88 / $14,290.87
| Facility | | $5,620.56 | $7,919.88 | $14,290.87 |
- 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
- $5,620.56 / $7,919.88 / $14,543.62
| Facility | | $5,620.56 | $7,919.88 | $14,543.62 |