- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,374.60 / $14,374.60 / $14,374.60
| Facility | | $14,374.60 | $14,374.60 | $14,374.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,049.02 / $11,438.51 / $11,438.51
| Facility | | $11,049.02 | $11,438.51 | $11,438.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,747.18 / $9,507.39 / $17,412.73
| Facility | | $6,747.18 | $9,507.39 | $17,412.73 |
- 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
- $6,747.18 / $9,507.39 / $17,458.84
| Facility | | $6,747.18 | $9,507.39 | $17,458.84 |