- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,584.40 / $18,584.40 / $18,584.40
| Facility | | $18,584.40 | $18,584.40 | $18,584.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,284.93 / $14,788.50 / $14,788.50
| Facility | | $14,284.93 | $14,788.50 | $14,788.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,723.21 / $12,291.81 / $22,884.52
| Facility | | $8,723.21 | $12,291.81 | $22,884.52 |
- 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
- $8,723.21 / $12,291.81 / $22,571.99
| Facility | | $8,723.21 | $12,291.81 | $22,571.99 |