- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,868.10 / $14,868.10 / $14,868.10
| Facility | | $14,868.10 | $14,868.10 | $14,868.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,428.38 / $11,831.25 / $11,831.25
| Facility | | $11,428.38 | $11,831.25 | $11,831.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,978.84 / $9,833.82 / $16,048.20
| Facility | | $6,978.84 | $9,833.82 | $16,048.20 |
- 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
- $6,978.84 / $9,833.82 / $18,058.28
| Facility | | $6,978.84 | $9,833.82 | $18,058.28 |