- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,026.20 / $18,026.20 / $18,026.20
| Facility | | $18,026.20 | $18,026.20 | $18,026.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,855.86 / $14,344.30 / $14,344.30
| Facility | | $13,855.86 | $14,344.30 | $14,344.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,461.20 / $11,922.60 / $22,712.03
| Facility | | $8,461.20 | $11,922.60 | $22,712.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.00 / $950.00 / $950.00
| Facility | | $950.00 | $950.00 | $950.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,461.20 / $11,922.60 / $21,894.00
| Facility | | $8,461.20 | $11,922.60 | $21,894.00 |