- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,052.10 / $21,052.10 / $21,052.10
| Facility | | $21,052.10 | $21,052.10 | $21,052.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,181.74 / $16,752.16 / $16,752.16
| Facility | | $16,181.74 | $16,752.16 | $16,752.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,881.52 / $13,923.96 / $27,160.71
| Facility | | $9,881.52 | $13,923.96 | $27,160.71 |
- 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
- $9,881.52 / $13,923.96 / $25,569.18
| Facility | | $9,881.52 | $13,923.96 | $25,569.18 |