- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,204.50 / $19,204.50 / $19,204.50
| Facility | | $19,204.50 | $19,204.50 | $19,204.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,761.57 / $15,281.94 / $15,281.94
| Facility | | $14,761.57 | $15,281.94 | $15,281.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,014.28 / $12,701.94 / $22,501.97
| Facility | | $9,014.28 | $12,701.94 | $22,501.97 |
- 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
- $9,014.28 / $12,701.94 / $23,325.13
| Facility | | $9,014.28 | $12,701.94 | $23,325.13 |