- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,448.30 / $17,448.30 / $17,448.30
| Facility | | $17,448.30 | $17,448.30 | $17,448.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,411.65 / $13,884.43 / $13,884.43
| Facility | | $13,411.65 | $13,884.43 | $13,884.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,189.94 / $11,540.37 / $20,896.64
| Facility | | $8,189.94 | $11,540.37 | $20,896.64 |
- 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
- $8,189.94 / $11,540.37 / $21,192.09
| Facility | | $8,189.94 | $11,540.37 | $21,192.09 |