- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,603.00 / $17,603.00 / $17,603.00
| Facility | | $17,603.00 | $17,603.00 | $17,603.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,530.54 / $14,007.51 / $14,007.51
| Facility | | $13,530.54 | $14,007.51 | $14,007.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,262.54 / $11,642.67 / $17,130.93
| Facility | | $8,262.54 | $11,642.67 | $17,130.93 |
- 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
- $8,262.54 / $11,642.67 / $21,379.95
| Facility | | $8,262.54 | $11,642.67 | $21,379.95 |