- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,403.00 / $18,403.00 / $18,403.00
| Facility | | $18,403.00 | $18,403.00 | $18,403.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,145.51 / $14,644.16 / $14,644.16
| Facility | | $14,145.51 | $14,644.16 | $14,644.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,638.08 / $12,171.84 / $21,499.49
| Facility | | $8,638.08 | $12,171.84 | $21,499.49 |
- 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
- $8,638.08 / $12,171.84 / $22,351.69
| Facility | | $8,638.08 | $12,171.84 | $22,351.69 |