- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,383.70 / $22,383.70 / $22,383.70
| Facility | | $22,383.70 | $22,383.70 | $22,383.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,205.25 / $17,811.77 / $17,811.77
| Facility | | $17,205.25 | $17,811.77 | $17,811.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,506.54 / $14,804.67 / $28,520.26
| Facility | | $10,506.54 | $14,804.67 | $28,520.26 |
- 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
- $10,506.54 / $14,804.67 / $27,186.47
| Facility | | $10,506.54 | $14,804.67 | $27,186.47 |