- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,768.50 / $13,768.50 / $13,768.50
| Facility | | $13,768.50 | $13,768.50 | $13,768.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,583.19 / $10,956.27 / $10,956.27
| Facility | | $10,583.19 | $10,956.27 | $10,956.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,462.72 / $9,106.56 / $15,735.67
| Facility | | $6,462.72 | $9,106.56 | $15,735.67 |
- 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
- $6,462.72 / $9,106.56 / $16,722.78
| Facility | | $6,462.72 | $9,106.56 | $16,722.78 |