- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,522.00 / $20,522.00 / $20,522.00
| Facility | | $20,522.00 | $20,522.00 | $20,522.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,774.28 / $16,330.35 / $16,330.35
| Facility | | $15,774.28 | $16,330.35 | $16,330.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,632.70 / $13,573.35 / $23,931.40
| Facility | | $9,632.70 | $13,573.35 | $23,931.40 |
- 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
- $9,632.70 / $13,573.35 / $24,925.34
| Facility | | $9,632.70 | $13,573.35 | $24,925.34 |