- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,447.20 / $21,447.20 / $21,447.20
| Facility | | $21,447.20 | $21,447.20 | $21,447.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,485.43 / $17,066.58 / $17,066.58
| Facility | | $16,485.43 | $17,066.58 | $17,066.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,066.98 / $14,185.29 / $26,436.74
| Facility | | $10,066.98 | $14,185.29 | $26,436.74 |
- 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
- $10,066.98 / $14,185.29 / $26,049.07
| Facility | | $10,066.98 | $14,185.29 | $26,049.07 |