- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,217.40 / $18,217.40 / $18,217.40
| Facility | | $18,217.40 | $18,217.40 | $18,217.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,002.84 / $14,496.47 / $14,496.47
| Facility | | $14,002.84 | $14,496.47 | $14,496.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,550.95 / $12,049.08 / $22,788.88
| Facility | | $8,550.95 | $12,049.08 | $22,788.88 |
- 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
- $8,550.95 / $12,049.08 / $22,126.26
| Facility | | $8,550.95 | $12,049.08 | $22,126.26 |