- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,224.40 / $13,224.40 / $13,224.40
| Facility | | $13,224.40 | $13,224.40 | $13,224.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,164.92 / $10,523.25 / $10,523.25
| Facility | | $10,164.92 | $10,523.25 | $10,523.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,207.30 / $8,746.65 / $15,585.38
| Facility | | $6,207.30 | $8,746.65 | $15,585.38 |
- 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
- $6,207.30 / $8,746.65 / $16,061.86
| Facility | | $6,207.30 | $8,746.65 | $16,061.86 |