- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,038.60 / $35,038.60 / $35,038.60
| Facility | | $35,038.60 | $35,038.60 | $35,038.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,932.46 / $27,881.87 / $27,881.87
| Facility | | $26,932.46 | $27,881.87 | $27,881.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,446.54 / $23,174.67 / $41,306.56
| Facility | | $16,446.54 | $23,174.67 | $41,306.56 |
- 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
- $16,446.54 / $23,174.67 / $42,556.67
| Facility | | $16,446.54 | $23,174.67 | $42,556.67 |