- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,678.40 / $19,678.40 / $19,678.40
| Facility | | $19,678.40 | $19,678.40 | $19,678.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,125.80 / $15,659.01 / $15,659.01
| Facility | | $15,125.80 | $15,659.01 | $15,659.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,236.70 / $13,015.35 / $25,094.41
| Facility | | $9,236.70 | $13,015.35 | $25,094.41 |
- 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
- $9,236.70 / $13,015.35 / $23,900.66
| Facility | | $9,236.70 | $13,015.35 | $23,900.66 |