- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,886.40 / $14,886.40 / $14,886.40
| Facility | | $14,886.40 | $14,886.40 | $14,886.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,442.43 / $11,845.79 / $11,845.79
| Facility | | $11,442.43 | $11,845.79 | $11,845.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,987.42 / $9,845.91 / $18,801.16
| Facility | | $6,987.42 | $9,845.91 | $18,801.16 |
- 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
- $6,987.42 / $9,845.91 / $18,080.48
| Facility | | $6,987.42 | $9,845.91 | $18,080.48 |