- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,582.20 / $21,582.20 / $21,582.20
| Facility | | $21,582.20 | $21,582.20 | $21,582.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,589.20 / $17,174.00 / $17,174.00
| Facility | | $16,589.20 | $17,174.00 | $17,174.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,130.34 / $14,274.57 / $26,146.42
| Facility | | $10,130.34 | $14,274.57 | $26,146.42 |
- 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
- $10,130.34 / $14,274.57 / $26,213.02
| Facility | | $10,130.34 | $14,274.57 | $26,213.02 |