- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,651.40 / $20,651.40 / $20,651.40
| Facility | | $20,651.40 | $20,651.40 | $20,651.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,873.71 / $16,433.28 / $16,433.28
| Facility | | $15,873.71 | $16,433.28 | $16,433.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,693.42 / $13,658.91 / $24,846.78
| Facility | | $9,693.42 | $13,658.91 | $24,846.78 |
- 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
- $9,693.42 / $13,658.91 / $25,082.46
| Facility | | $9,693.42 | $13,658.91 | $25,082.46 |