- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,834.10 / $15,834.10 / $15,834.10
| Facility | | $15,834.10 | $15,834.10 | $15,834.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,170.89 / $12,599.93 / $12,599.93
| Facility | | $12,170.89 | $12,599.93 | $12,599.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,432.26 / $10,472.73 / $19,446.72
| Facility | | $7,432.26 | $10,472.73 | $19,446.72 |
- 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
- $7,432.26 / $10,472.73 / $19,231.54
| Facility | | $7,432.26 | $10,472.73 | $19,231.54 |