- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,554.30 / $15,554.30 / $15,554.30
| Facility | | $15,554.30 | $15,554.30 | $15,554.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,955.81 / $12,377.27 / $12,377.27
| Facility | | $11,955.81 | $12,377.27 | $12,377.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,300.92 / $10,287.66 / $17,552.77
| Facility | | $7,300.92 | $10,287.66 | $17,552.77 |
- 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
- $7,300.92 / $10,287.66 / $18,891.68
| Facility | | $7,300.92 | $10,287.66 | $18,891.68 |