- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,454.20 / $16,454.20 / $16,454.20
| Facility | | $16,454.20 | $16,454.20 | $16,454.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,647.52 / $13,093.37 / $13,093.37
| Facility | | $12,647.52 | $13,093.37 | $13,093.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,723.32 / $10,882.86 / $21,228.60
| Facility | | $7,723.32 | $10,882.86 | $21,228.60 |
- 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
- $7,723.32 / $10,882.86 / $19,984.68
| Facility | | $7,723.32 | $10,882.86 | $19,984.68 |