- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,506.80 / $19,506.80 / $19,506.80
| Facility | | $19,506.80 | $19,506.80 | $19,506.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,993.94 / $15,522.50 / $15,522.50
| Facility | | $14,993.94 | $15,522.50 | $15,522.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,156.18 / $12,901.89 / $23,265.36
| Facility | | $9,156.18 | $12,901.89 | $23,265.36 |
- 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
- $9,156.18 / $12,901.89 / $23,692.31
| Facility | | $9,156.18 | $12,901.89 | $23,692.31 |