- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,677.20 / $18,677.20 / $18,677.20
| Facility | | $18,677.20 | $18,677.20 | $18,677.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,356.27 / $14,862.35 / $14,862.35
| Facility | | $14,356.27 | $14,862.35 | $14,862.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,766.78 / $12,353.19 / $21,636.12
| Facility | | $8,766.78 | $12,353.19 | $21,636.12 |
- 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
- $8,766.78 / $12,353.19 / $22,684.71
| Facility | | $8,766.78 | $12,353.19 | $22,684.71 |