- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,765.70 / $13,765.70 / $13,765.70
| Facility | | $13,765.70 | $13,765.70 | $13,765.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,581.03 / $10,954.03 / $10,954.03
| Facility | | $10,581.03 | $10,954.03 | $10,954.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,461.40 / $9,104.70 / $17,407.61
| Facility | | $6,461.40 | $9,104.70 | $17,407.61 |
- 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
- $6,461.40 / $9,104.70 / $16,719.36
| Facility | | $6,461.40 | $9,104.70 | $16,719.36 |