- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,277.10 / $21,277.10 / $21,277.10
| Facility | | $21,277.10 | $21,277.10 | $21,277.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,354.67 / $16,931.18 / $16,931.18
| Facility | | $16,354.67 | $16,931.18 | $16,931.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,987.12 / $14,072.76 / $27,450.96
| Facility | | $9,987.12 | $14,072.76 | $27,450.96 |
- 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
- $9,987.12 / $14,072.76 / $25,842.43
| Facility | | $9,987.12 | $14,072.76 | $25,842.43 |