- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,276.10 / $14,276.10 / $14,276.10
| Facility | | $14,276.10 | $14,276.10 | $14,276.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,973.36 / $11,360.19 / $11,360.19
| Facility | | $10,973.36 | $11,360.19 | $11,360.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,700.98 / $9,442.29 / $16,705.70
| Facility | | $6,700.98 | $9,442.29 | $16,705.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,450.00 / $1,450.00 / $1,450.00
| Facility | | $1,450.00 | $1,450.00 | $1,450.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,700.98 / $9,442.29 / $17,339.29
| Facility | | $6,700.98 | $9,442.29 | $17,339.29 |