- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,679.20 / $16,679.20 / $16,679.20
| Facility | | $16,679.20 | $16,679.20 | $16,679.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,820.45 / $13,272.39 / $13,272.39
| Facility | | $12,820.45 | $13,272.39 | $13,272.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,828.92 / $11,031.66 / $21,267.23
| Facility | | $7,828.92 | $11,031.66 | $21,267.23 |
- 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
- $7,828.92 / $11,031.66 / $20,257.91
| Facility | | $7,828.92 | $11,031.66 | $20,257.91 |