- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,432.70 / $28,432.70 / $28,432.70
| Facility | | $28,432.70 | $28,432.70 | $28,432.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,854.86 / $22,625.28 / $22,625.28
| Facility | | $21,854.86 | $22,625.28 | $22,625.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,345.86 / $18,805.53 / $30,018.00
| Facility | | $13,345.86 | $18,805.53 | $30,018.00 |
- 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
- $14,787.62 / $21,141.06 / $34,602.18
| Facility | | $14,787.62 | $21,141.06 | $34,602.18 |