- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,357.40 / $15,357.40 / $15,357.40
| Facility | | $15,357.40 | $15,357.40 | $15,357.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,804.50 / $12,220.63 / $12,220.63
| Facility | | $11,804.50 | $12,220.63 | $12,220.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,208.52 / $10,157.45 / $15,231.87
| Facility | | $7,208.52 | $10,157.45 | $15,231.87 |
- 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
- $7,208.52 / $10,157.45 / $18,652.59
| Facility | | $7,208.52 | $10,157.45 | $18,652.59 |