- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,974.40 / $16,974.40 / $16,974.40
| Facility | | $16,974.40 | $16,974.40 | $16,974.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,047.42 / $13,507.36 / $13,507.36
| Facility | | $13,047.42 | $13,507.36 | $13,507.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,967.52 / $11,226.96 / $20,580.70
| Facility | | $7,967.52 | $11,226.96 | $20,580.70 |
- 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
- $7,967.52 / $11,226.96 / $20,616.56
| Facility | | $7,967.52 | $11,226.96 | $20,616.56 |