- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,701.00 / $13,701.00 / $13,701.00
| Facility | | $13,701.00 | $13,701.00 | $13,701.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,531.32 / $10,902.56 / $10,902.56
| Facility | | $10,531.32 | $10,902.56 | $10,902.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,431.04 / $9,061.92 / $17,414.43
| Facility | | $6,431.04 | $9,061.92 | $17,414.43 |
- 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
- $6,431.04 / $9,061.92 / $16,640.80
| Facility | | $6,431.04 | $9,061.92 | $16,640.80 |