- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,178.80 / $15,178.80 / $15,178.80
| Facility | | $15,178.80 | $15,178.80 | $15,178.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,667.24 / $12,078.53 / $12,078.53
| Facility | | $11,667.24 | $12,078.53 | $12,078.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,124.70 / $10,039.35 / $18,690.16
| Facility | | $7,124.70 | $10,039.35 | $18,690.16 |
- 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
- $7,894.38 / $11,286.17 / $18,472.40
| Facility | | $7,894.38 | $11,286.17 | $18,472.40 |