- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,851.20 / $14,851.20 / $14,851.20
| Facility | | $14,851.20 | $14,851.20 | $14,851.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,415.41 / $11,817.82 / $11,817.82
| Facility | | $11,415.41 | $11,817.82 | $11,817.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,970.92 / $9,822.66 / $18,270.04
| Facility | | $6,970.92 | $9,822.66 | $18,270.04 |
- 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
- $6,970.92 / $9,822.66 / $18,037.78
| Facility | | $6,970.92 | $9,822.66 | $18,037.78 |