- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,858.09 / $20,858.09 / $20,858.09
| Facility | | $20,858.09 | $20,858.09 | $20,858.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,032.59 / $16,597.75 / $16,597.75
| Facility | | $16,032.59 | $16,597.75 | $16,597.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,790.44 / $13,795.62 / $26,910.36
| Facility | | $9,790.44 | $13,795.62 | $26,910.36 |
- 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
- $9,790.44 / $13,795.62 / $25,333.51
| Facility | | $9,790.44 | $13,795.62 | $25,333.51 |