- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,732.59 / $16,732.59 / $16,732.59
| Facility | | $16,732.59 | $16,732.59 | $16,732.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,861.52 / $13,314.91 / $13,314.91
| Facility | | $12,861.52 | $13,314.91 | $13,314.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,854.00 / $11,067.00 / $20,063.23
| Facility | | $7,854.00 | $11,067.00 | $20,063.23 |
- 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
- $7,854.00 / $11,067.00 / $20,322.82
| Facility | | $7,854.00 | $11,067.00 | $20,322.82 |