- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,626.30 / $19,626.30 / $19,626.30
| Facility | | $19,626.30 | $19,626.30 | $19,626.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,085.81 / $15,617.61 / $15,617.61
| Facility | | $15,085.81 | $15,617.61 | $15,617.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,212.28 / $12,980.94 / $23,745.25
| Facility | | $9,212.28 | $12,980.94 | $23,745.25 |
- 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
- $9,212.28 / $12,980.94 / $23,837.47
| Facility | | $9,212.28 | $12,980.94 | $23,837.47 |