- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,962.60 / $29,962.60 / $29,962.60
| Facility | | $29,962.60 | $29,962.60 | $29,962.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,030.77 / $23,842.64 / $23,842.64
| Facility | | $23,030.77 | $23,842.64 | $23,842.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,063.94 / $19,817.37 / $38,473.32
| Facility | | $14,063.94 | $19,817.37 | $38,473.32 |
- 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
- $14,063.94 / $19,817.37 / $36,391.51
| Facility | | $14,063.94 | $19,817.37 | $36,391.51 |