- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,738.80 / $19,738.80 / $19,738.80
| Facility | | $19,738.80 | $19,738.80 | $19,738.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,172.27 / $15,707.12 / $15,707.12
| Facility | | $15,172.27 | $15,707.12 | $15,707.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,265.08 / $13,055.34 / $23,991.17
| Facility | | $9,265.08 | $13,055.34 | $23,991.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.00 / $950.00 / $950.00
| Facility | | $950.00 | $950.00 | $950.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,265.08 / $13,055.34 / $23,974.10
| Facility | | $9,265.08 | $13,055.34 | $23,974.10 |