- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,656.20 / $23,656.20 / $23,656.20
| Facility | | $23,656.20 | $23,656.20 | $23,656.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,183.38 / $18,824.37 / $18,824.37
| Facility | | $18,183.38 | $18,824.37 | $18,824.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,103.84 / $15,646.32 / $29,051.39
| Facility | | $11,103.84 | $15,646.32 | $29,051.39 |
- 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
- $11,103.84 / $15,646.32 / $28,732.03
| Facility | | $11,103.84 | $15,646.32 | $28,732.03 |