- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,962.30 / $14,962.30 / $14,962.30
| Facility | | $14,962.30 | $14,962.30 | $14,962.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,500.79 / $11,906.21 / $11,906.21
| Facility | | $11,500.79 | $11,906.21 | $11,906.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,023.06 / $9,896.12 / $18,241.00
| Facility | | $7,023.06 | $9,896.12 | $18,241.00 |
- 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
- $7,023.06 / $9,896.12 / $18,172.70
| Facility | | $7,023.06 | $9,896.12 | $18,172.70 |