- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,555.30 / $22,555.30 / $22,555.30
| Facility | | $22,555.30 | $22,555.30 | $22,555.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,337.11 / $17,948.27 / $17,948.27
| Facility | | $17,337.11 | $17,948.27 | $17,948.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,587.06 / $14,918.13 / $28,031.83
| Facility | | $10,587.06 | $14,918.13 | $28,031.83 |
- 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
- $10,587.06 / $14,918.13 / $27,394.82
| Facility | | $10,587.06 | $14,918.13 | $27,394.82 |