- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,598.30 / $24,598.30 / $24,598.30
| Facility | | $24,598.30 | $24,598.30 | $24,598.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,907.52 / $19,574.04 / $19,574.04
| Facility | | $18,907.52 | $19,574.04 | $19,574.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,546.04 / $16,269.42 / $28,851.57
| Facility | | $11,546.04 | $16,269.42 | $28,851.57 |
- 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
- $11,546.04 / $16,269.42 / $29,876.25
| Facility | | $11,546.04 | $16,269.42 | $29,876.25 |