- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,408.80 / $23,408.80 / $23,408.80
| Facility | | $23,408.80 | $23,408.80 | $23,408.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,993.16 / $18,627.45 / $18,627.45
| Facility | | $17,993.16 | $18,627.45 | $18,627.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,987.68 / $15,482.64 / $29,695.23
| Facility | | $10,987.68 | $15,482.64 | $29,695.23 |
- 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
- $10,987.68 / $15,482.64 / $28,431.45
| Facility | | $10,987.68 | $15,482.64 | $28,431.45 |