- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,030.50 / $23,030.50 / $23,030.50
| Facility | | $23,030.50 | $23,030.50 | $23,030.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,702.41 / $18,326.46 / $18,326.46
| Facility | | $17,702.41 | $18,326.46 | $18,326.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,810.14 / $15,232.47 / $28,325.57
| Facility | | $10,810.14 | $15,232.47 | $28,325.57 |
- 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
- $10,810.14 / $15,232.47 / $27,972.06
| Facility | | $10,810.14 | $15,232.47 | $27,972.06 |