- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,420.40 / $16,420.40 / $16,420.40
| Facility | | $16,420.40 | $16,420.40 | $16,420.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,621.58 / $13,066.51 / $13,066.51
| Facility | | $12,621.58 | $13,066.51 | $13,066.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,707.48 / $10,860.54 / $18,830.20
| Facility | | $7,707.48 | $10,860.54 | $18,830.20 |
- 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
- $7,707.48 / $10,860.54 / $19,943.68
| Facility | | $7,707.48 | $10,860.54 | $19,943.68 |