- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,761.00 / $15,761.00 / $15,761.00
| Facility | | $15,761.00 | $15,761.00 | $15,761.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,114.69 / $12,541.75 / $12,541.75
| Facility | | $12,114.69 | $12,541.75 | $12,541.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,397.94 / $10,424.37 / $19,801.93
| Facility | | $7,397.94 | $10,424.37 | $19,801.93 |
- 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
- $7,397.94 / $10,424.37 / $19,142.73
| Facility | | $7,397.94 | $10,424.37 | $19,142.73 |