- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,885.30 / $18,885.30 / $18,885.30
| Facility | | $18,885.30 | $18,885.30 | $18,885.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,516.22 / $15,027.95 / $15,027.95
| Facility | | $14,516.22 | $15,027.95 | $15,027.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,864.45 / $12,490.83 / $21,038.39
| Facility | | $8,864.45 | $12,490.83 | $21,038.39 |
- 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
- $8,864.45 / $12,490.83 / $22,937.46
| Facility | | $8,864.45 | $12,490.83 | $22,937.46 |