- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.70 / $14,454.70 / $14,454.70
| Facility | | $14,454.70 | $14,454.70 | $14,454.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,110.62 / $11,502.29 / $11,502.29
| Facility | | $11,110.62 | $11,502.29 | $11,502.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,784.80 / $9,560.40 / $18,118.05
| Facility | | $6,784.80 | $9,560.40 | $18,118.05 |
- 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
- $6,784.80 / $9,560.40 / $17,556.18
| Facility | | $6,784.80 | $9,560.40 | $17,556.18 |