- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,157.30 / $22,157.30 / $22,157.30
| Facility | | $22,157.30 | $22,157.30 | $22,157.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,031.25 / $17,631.63 / $17,631.63
| Facility | | $17,031.25 | $17,631.63 | $17,631.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,400.28 / $14,654.94 / $25,572.60
| Facility | | $10,400.28 | $14,654.94 | $25,572.60 |
- 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
- $10,400.28 / $14,654.94 / $26,911.51
| Facility | | $10,400.28 | $14,654.94 | $26,911.51 |