- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,436.00 / $21,436.00 / $21,436.00
| Facility | | $21,436.00 | $21,436.00 | $21,436.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,476.80 / $17,057.63 / $17,057.63
| Facility | | $16,476.80 | $17,057.63 | $17,057.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,061.70 / $14,177.85 / $25,693.85
| Facility | | $10,061.70 | $14,177.85 | $25,693.85 |
- 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
- $10,061.70 / $14,177.85 / $26,035.41
| Facility | | $10,061.70 | $14,177.85 | $26,035.41 |