- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,563.30 / $29,563.30 / $29,563.30
| Facility | | $29,563.30 | $29,563.30 | $29,563.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,723.82 / $23,524.87 / $23,524.87
| Facility | | $22,723.82 | $23,524.87 | $23,524.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,876.50 / $19,553.25 / $36,403.46
| Facility | | $13,876.50 | $19,553.25 | $36,403.46 |
- 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
- $13,876.50 / $19,553.25 / $35,906.50
| Facility | | $13,876.50 | $19,553.25 | $35,906.50 |