- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,067.50 / $16,067.50 / $16,067.50
| Facility | | $16,067.50 | $16,067.50 | $16,067.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,350.30 / $12,785.67 / $12,785.67
| Facility | | $12,350.30 | $12,785.67 | $12,785.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,541.82 / $10,627.11 / $19,176.89
| Facility | | $7,541.82 | $10,627.11 | $19,176.89 |
- 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
- $7,541.82 / $10,627.11 / $19,515.03
| Facility | | $7,541.82 | $10,627.11 | $19,515.03 |