- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,741.80 / $13,741.80 / $13,741.80
| Facility | | $13,741.80 | $13,741.80 | $13,741.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,562.66 / $10,935.01 / $10,935.01
| Facility | | $10,562.66 | $10,935.01 | $10,935.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,450.18 / $9,088.89 / $16,321.44
| Facility | | $6,450.18 | $9,088.89 | $16,321.44 |
- 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
- $6,450.18 / $9,088.89 / $16,690.33
| Facility | | $6,450.18 | $9,088.89 | $16,690.33 |