- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,384.40 / $14,384.40 / $14,384.40
| Facility | | $14,384.40 | $14,384.40 | $14,384.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,056.58 / $11,446.35 / $11,446.35
| Facility | | $11,056.58 | $11,446.35 | $11,446.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,751.80 / $9,513.90 / $18,080.48
| Facility | | $6,751.80 | $9,513.90 | $18,080.48 |
- 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
- $6,751.80 / $9,513.90 / $17,470.79
| Facility | | $6,751.80 | $9,513.90 | $17,470.79 |