- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,008.20 / $17,008.20 / $17,008.20
| Facility | | $17,008.20 | $17,008.20 | $17,008.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,073.36 / $13,534.21 / $13,534.21
| Facility | | $13,073.36 | $13,534.21 | $13,534.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,983.36 / $11,249.28 / $20,983.74
| Facility | | $7,983.36 | $11,249.28 | $20,983.74 |
- 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
- $7,983.36 / $11,249.28 / $20,657.55
| Facility | | $7,983.36 | $11,249.28 | $20,657.55 |