- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,575.40 / $15,575.40 / $15,575.40
| Facility | | $15,575.40 | $15,575.40 | $15,575.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,972.02 / $12,394.06 / $12,394.06
| Facility | | $11,972.02 | $12,394.06 | $12,394.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,310.82 / $10,301.61 / $19,178.59
| Facility | | $7,310.82 | $10,301.61 | $19,178.59 |
- 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
- $7,310.82 / $10,301.61 / $18,917.30
| Facility | | $7,310.82 | $10,301.61 | $18,917.30 |