- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,923.50 / $12,923.50 / $12,923.50
| Facility | | $12,923.50 | $12,923.50 | $12,923.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,933.62 / $10,283.81 / $10,283.81
| Facility | | $9,933.62 | $10,283.81 | $10,283.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,066.06 / $8,547.62 / $15,742.50
| Facility | | $6,066.06 | $8,547.62 | $15,742.50 |
- 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
- $6,066.06 / $8,547.62 / $15,696.39
| Facility | | $6,066.06 | $8,547.62 | $15,696.39 |