- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,675.59 / $19,675.59 / $19,675.59
| Facility | | $19,675.59 | $19,675.59 | $19,675.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,123.63 / $15,656.77 / $15,656.77
| Facility | | $15,123.63 | $15,656.77 | $15,656.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,235.37 / $13,013.49 / $24,472.77
| Facility | | $9,235.37 | $13,013.49 | $24,472.77 |
- 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
- $9,235.37 / $13,013.49 / $23,897.25
| Facility | | $9,235.37 | $13,013.49 | $23,897.25 |