- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,702.30 / $19,702.30 / $19,702.30
| Facility | | $19,702.30 | $19,702.30 | $19,702.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,144.17 / $15,678.03 / $15,678.03
| Facility | | $15,144.17 | $15,678.03 | $15,678.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,247.92 / $13,031.16 / $25,419.17
| Facility | | $9,247.92 | $13,031.16 | $25,419.17 |
- 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
- $9,247.92 / $13,031.16 / $23,929.69
| Facility | | $9,247.92 | $13,031.16 | $23,929.69 |