- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,445.50 / $17,445.50 / $17,445.50
| Facility | | $17,445.50 | $17,445.50 | $17,445.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,409.49 / $13,882.19 / $13,882.19
| Facility | | $13,409.49 | $13,882.19 | $13,882.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,188.62 / $11,538.51 / $20,471.40
| Facility | | $8,188.62 | $11,538.51 | $20,471.40 |
- 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
- $8,188.62 / $11,538.51 / $21,188.67
| Facility | | $8,188.62 | $11,538.51 | $21,188.67 |