- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,482.00 / $12,482.00 / $12,482.00
| Facility | | $12,482.00 | $12,482.00 | $12,482.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,594.26 / $9,932.48 / $9,932.48
| Facility | | $9,594.26 | $9,932.48 | $9,932.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,858.82 / $8,255.61 / $15,336.04
| Facility | | $5,858.82 | $8,255.61 | $15,336.04 |
- 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
- $5,858.82 / $8,255.61 / $15,160.14
| Facility | | $5,858.82 | $8,255.61 | $15,160.14 |