- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,929.40 / $16,929.40 / $16,929.40
| Facility | | $16,929.40 | $16,929.40 | $16,929.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,012.83 / $13,471.56 / $13,471.56
| Facility | | $13,012.83 | $13,471.56 | $13,471.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,946.40 / $11,197.20 / $20,594.36
| Facility | | $7,946.40 | $11,197.20 | $20,594.36 |
- 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
- $7,946.40 / $11,197.20 / $20,561.91
| Facility | | $7,946.40 | $11,197.20 | $20,561.91 |