- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,984.40 / $21,984.40 / $21,984.40
| Facility | | $21,984.40 | $21,984.40 | $21,984.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,898.31 / $17,494.00 / $17,494.00
| Facility | | $16,898.31 | $17,494.00 | $17,494.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,319.10 / $14,540.55 / $27,773.95
| Facility | | $10,319.10 | $14,540.55 | $27,773.95 |
- 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
- $10,319.10 / $14,540.55 / $26,701.45
| Facility | | $10,319.10 | $14,540.55 | $26,701.45 |