- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,293.20 / $24,293.20 / $24,293.20
| Facility | | $24,293.20 | $24,293.20 | $24,293.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,672.98 / $19,331.24 / $19,331.24
| Facility | | $18,672.98 | $19,331.24 | $19,331.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,402.82 / $16,067.61 / $30,016.29
| Facility | | $11,402.82 | $16,067.61 | $30,016.29 |
- 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
- $11,402.82 / $16,067.61 / $29,505.66
| Facility | | $11,402.82 | $16,067.61 | $29,505.66 |