- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,825.40 / $16,825.40 / $16,825.40
| Facility | | $16,825.40 | $16,825.40 | $16,825.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,932.85 / $13,388.76 / $13,388.76
| Facility | | $12,932.85 | $13,388.76 | $13,388.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,897.56 / $11,128.38 / $19,866.84
| Facility | | $7,897.56 | $11,128.38 | $19,866.84 |
- 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
- $7,897.56 / $11,128.38 / $20,435.53
| Facility | | $7,897.56 | $11,128.38 | $20,435.53 |