- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,914.10 / $21,914.10 / $21,914.10
| Facility | | $21,914.10 | $21,914.10 | $21,914.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,844.27 / $17,438.06 / $17,438.06
| Facility | | $16,844.27 | $17,438.06 | $17,438.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,286.10 / $14,494.05 / $26,983.24
| Facility | | $10,286.10 | $14,494.05 | $26,983.24 |
- 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
- $10,286.10 / $14,494.05 / $26,616.06
| Facility | | $10,286.10 | $14,494.05 | $26,616.06 |