- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,924.70 / $18,924.70 / $18,924.70
| Facility | | $18,924.70 | $18,924.70 | $18,924.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,546.49 / $15,059.28 / $15,059.28
| Facility | | $14,546.49 | $15,059.28 | $15,059.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,882.94 / $12,516.87 / $23,861.38
| Facility | | $8,882.94 | $12,516.87 | $23,861.38 |
- 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
- $8,882.94 / $12,516.87 / $22,985.28
| Facility | | $8,882.94 | $12,516.87 | $22,985.28 |