- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,014.20 / $21,014.20 / $21,014.20
| Facility | | $21,014.20 | $21,014.20 | $21,014.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,152.56 / $16,721.96 / $16,721.96
| Facility | | $16,152.56 | $16,721.96 | $16,721.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,863.70 / $13,898.85 / $26,686.08
| Facility | | $9,863.70 | $13,898.85 | $26,686.08 |
- 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
- $9,863.70 / $13,898.85 / $25,523.07
| Facility | | $9,863.70 | $13,898.85 | $25,523.07 |