- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,209.80 / $31,209.80 / $31,209.80
| Facility | | $31,209.80 | $31,209.80 | $31,209.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,989.44 / $24,835.10 / $24,835.10
| Facility | | $23,989.44 | $24,835.10 | $24,835.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,649.36 / $20,642.28 / $36,475.19
| Facility | | $14,649.36 | $20,642.28 | $36,475.19 |
- 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
- $14,649.36 / $20,642.28 / $37,906.33
| Facility | | $14,649.36 | $20,642.28 | $37,906.33 |