- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,291.40 / $20,291.40 / $20,291.40
| Facility | | $20,291.40 | $20,291.40 | $20,291.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,597.02 / $16,146.85 / $16,146.85
| Facility | | $15,597.02 | $16,146.85 | $16,146.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,524.45 / $13,420.83 / $24,578.66
| Facility | | $9,524.45 | $13,420.83 | $24,578.66 |
- 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
- $9,524.45 / $13,420.83 / $24,645.26
| Facility | | $9,524.45 | $13,420.83 | $24,645.26 |