- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,708.00 / $24,708.00 / $24,708.00
| Facility | | $24,708.00 | $24,708.00 | $24,708.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,991.82 / $19,661.31 / $19,661.31
| Facility | | $18,991.82 | $19,661.31 | $19,661.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,597.52 / $16,341.96 / $30,414.21
| Facility | | $11,597.52 | $16,341.96 | $30,414.21 |
- 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
- $11,597.52 / $16,341.96 / $30,009.46
| Facility | | $11,597.52 | $16,341.96 | $30,009.46 |