- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,572.40 / $21,572.40 / $21,572.40
| Facility | | $21,572.40 | $21,572.40 | $21,572.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,581.63 / $17,166.16 / $17,166.16
| Facility | | $16,581.63 | $17,166.16 | $17,166.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,125.71 / $14,268.06 / $25,318.14
| Facility | | $10,125.71 | $14,268.06 | $25,318.14 |
- 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
- $10,125.71 / $14,268.06 / $26,201.07
| Facility | | $10,125.71 | $14,268.06 | $26,201.07 |