- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,906.10 / $14,906.10 / $14,906.10
| Facility | | $14,906.10 | $14,906.10 | $14,906.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,388.98 / $11,861.46 / $11,861.46
| Facility | | $10,388.98 | $11,861.46 | $11,861.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,300.00 / $7,844.74 / $18,495.47
| Facility | | $4,300.00 | $7,844.74 | $18,495.47 |
- 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
- $4,300.00 / $7,844.74 / $18,104.39
| Facility | | $4,300.00 | $7,844.74 | $18,104.39 |