- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,904.40 / $15,904.40 / $15,904.40
| Facility | | $15,904.40 | $15,904.40 | $15,904.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,224.93 / $12,655.88 / $12,655.88
| Facility | | $12,224.93 | $12,655.88 | $12,655.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,465.26 / $10,519.23 / $19,258.86
| Facility | | $7,465.26 | $10,519.23 | $19,258.86 |
- 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
- $7,465.26 / $10,519.23 / $19,316.93
| Facility | | $7,465.26 | $10,519.23 | $19,316.93 |