- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,051.50 / $18,051.50 / $18,051.50
| Facility | | $18,051.50 | $18,051.50 | $18,051.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,875.31 / $14,364.44 / $14,364.44
| Facility | | $13,875.31 | $14,364.44 | $14,364.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,473.08 / $11,939.34 / $22,283.37
| Facility | | $8,473.08 | $11,939.34 | $22,283.37 |
- 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
- $8,473.08 / $11,939.34 / $21,924.74
| Facility | | $8,473.08 | $11,939.34 | $21,924.74 |