- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,640.40 / $19,640.40 / $19,640.40
| Facility | | $19,640.40 | $19,640.40 | $19,640.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,096.61 / $15,628.80 / $15,628.80
| Facility | | $15,096.61 | $15,628.80 | $15,628.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,218.87 / $12,990.24 / $24,073.15
| Facility | | $9,218.87 | $12,990.24 | $24,073.15 |
- 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
- $9,218.87 / $12,990.24 / $23,854.55
| Facility | | $9,218.87 | $12,990.24 | $23,854.55 |