- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,862.00 / $16,862.00 / $16,862.00
| Facility | | $16,862.00 | $16,862.00 | $16,862.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,960.95 / $13,417.85 / $13,417.85
| Facility | | $12,960.95 | $13,417.85 | $13,417.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,914.72 / $11,152.56 / $19,733.63
| Facility | | $7,914.72 | $11,152.56 | $19,733.63 |
- 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
- $7,914.72 / $11,152.56 / $20,479.93
| Facility | | $7,914.72 | $11,152.56 | $20,479.93 |