- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,874.20 / $23,874.20 / $23,874.20
| Facility | | $23,874.20 | $23,874.20 | $23,874.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,350.90 / $18,997.80 / $18,997.80
| Facility | | $18,350.90 | $18,997.80 | $18,997.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,206.14 / $15,790.47 / $28,925.01
| Facility | | $11,206.14 | $15,790.47 | $28,925.01 |
- 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
- $11,206.14 / $15,790.47 / $28,996.74
| Facility | | $11,206.14 | $15,790.47 | $28,996.74 |