- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,907.70 / $13,907.70 / $13,907.70
| Facility | | $13,907.70 | $13,907.70 | $13,907.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,690.19 / $11,067.04 / $11,067.04
| Facility | | $10,690.19 | $11,067.04 | $11,067.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,528.06 / $9,198.62 / $17,146.31
| Facility | | $6,528.06 | $9,198.62 | $17,146.31 |
- 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
- $6,528.06 / $9,198.62 / $16,891.84
| Facility | | $6,528.06 | $9,198.62 | $16,891.84 |