- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,961.90 / $21,961.90 / $21,961.90
| Facility | | $21,961.90 | $21,961.90 | $21,961.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,881.02 / $17,476.09 / $17,476.09
| Facility | | $16,881.02 | $17,476.09 | $17,476.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,308.54 / $14,525.67 / $27,980.60
| Facility | | $10,308.54 | $14,525.67 | $27,980.60 |
- 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
- $10,308.54 / $14,525.67 / $26,674.13
| Facility | | $10,308.54 | $14,525.67 | $26,674.13 |