- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,973.90 / $18,973.90 / $18,973.90
| Facility | | $18,973.90 | $18,973.90 | $18,973.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,584.32 / $15,098.44 / $15,098.44
| Facility | | $14,584.32 | $15,098.44 | $15,098.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,906.04 / $12,549.42 / $21,019.60
| Facility | | $8,906.04 | $12,549.42 | $21,019.60 |
- 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
- $8,906.04 / $12,549.42 / $23,045.05
| Facility | | $8,906.04 | $12,549.42 | $23,045.05 |