- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,866.70 / $30,866.70 / $30,866.70
| Facility | | $30,866.70 | $30,866.70 | $30,866.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,725.72 / $24,562.09 / $24,562.09
| Facility | | $23,725.72 | $24,562.09 | $24,562.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,488.32 / $20,415.36 / $38,005.37
| Facility | | $14,488.32 | $20,415.36 | $38,005.37 |
- 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
- $14,488.32 / $20,415.36 / $37,489.62
| Facility | | $14,488.32 | $20,415.36 | $37,489.62 |