- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,345.30 / $13,345.30 / $13,345.30
| Facility | | $13,345.30 | $13,345.30 | $13,345.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,257.87 / $10,619.48 / $10,619.48
| Facility | | $10,257.87 | $10,619.48 | $10,619.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,264.06 / $8,826.62 / $16,907.22
| Facility | | $6,264.06 | $8,826.62 | $16,907.22 |
- 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
- $6,264.06 / $8,826.62 / $16,208.73
| Facility | | $6,264.06 | $8,826.62 | $16,208.73 |