- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,241.50 / $12,241.50 / $12,241.50
| Facility | | $12,241.50 | $12,241.50 | $12,241.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,409.44 / $9,741.14 / $9,741.14
| Facility | | $9,409.44 | $9,741.14 | $9,741.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,745.96 / $8,096.58 / $15,044.01
| Facility | | $5,745.96 | $8,096.58 | $15,044.01 |
- 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
- $5,745.96 / $8,096.58 / $14,868.11
| Facility | | $5,745.96 | $8,096.58 | $14,868.11 |