- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,445.70 / $16,445.70 / $16,445.70
| Facility | | $16,445.70 | $16,445.70 | $16,445.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,641.04 / $13,086.65 / $13,086.65
| Facility | | $12,641.04 | $13,086.65 | $13,086.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,719.36 / $10,877.28 / $20,819.79
| Facility | | $7,719.36 | $10,877.28 | $20,819.79 |
- 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
- $7,719.36 / $10,877.28 / $19,974.43
| Facility | | $7,719.36 | $10,877.28 | $19,974.43 |