- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,815.40 / $22,815.40 / $22,815.40
| Facility | | $22,815.40 | $22,815.40 | $22,815.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,537.06 / $18,155.27 / $18,155.27
| Facility | | $17,537.06 | $18,155.27 | $18,155.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,709.16 / $15,090.18 / $27,517.78
| Facility | | $10,709.16 | $15,090.18 | $27,517.78 |
- 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
- $10,709.16 / $15,090.18 / $27,710.76
| Facility | | $10,709.16 | $15,090.18 | $27,710.76 |