- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,907.20 / $15,907.20 / $15,907.20
| Facility | | $15,907.20 | $15,907.20 | $15,907.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,227.09 / $12,658.12 / $12,658.12
| Facility | | $12,227.09 | $12,658.12 | $12,658.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,466.58 / $10,521.09 / $18,425.45
| Facility | | $7,466.58 | $10,521.09 | $18,425.45 |
- 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
- $7,466.58 / $10,521.09 / $19,320.34
| Facility | | $7,466.58 | $10,521.09 | $19,320.34 |