- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,716.20 / $14,716.20 / $14,716.20
| Facility | | $14,716.20 | $14,716.20 | $14,716.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,311.65 / $11,710.41 / $11,710.41
| Facility | | $11,311.65 | $11,710.41 | $11,710.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,907.56 / $9,733.37 / $16,254.84
| Facility | | $6,907.56 | $9,733.37 | $16,254.84 |
- 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
- $7,653.79 / $10,779.98 / $17,909.41
| Facility | | $7,653.79 | $10,779.98 | $17,909.41 |