- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,324.70 / $22,324.70 / $22,324.70
| Facility | | $22,324.70 | $22,324.70 | $22,324.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,159.86 / $17,764.78 / $17,764.78
| Facility | | $17,159.86 | $17,764.78 | $17,764.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,478.82 / $14,765.61 / $26,489.69
| Facility | | $10,478.82 | $14,765.61 | $26,489.69 |
- 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
- $10,478.82 / $14,765.61 / $27,114.74
| Facility | | $10,478.82 | $14,765.61 | $27,114.74 |