- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,336.60 / $14,336.60 / $14,336.60
| Facility | | $14,336.60 | $14,336.60 | $14,336.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,019.84 / $11,408.30 / $11,408.30
| Facility | | $11,019.84 | $11,408.30 | $11,408.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,729.36 / $9,482.28 / $18,496.56
| Facility | | $6,729.36 | $9,482.28 | $18,496.56 |
- 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
- $6,729.36 / $9,482.28 / $17,412.73
| Facility | | $6,729.36 | $9,482.28 | $17,412.73 |