- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,764.10 / $30,764.10 / $30,764.10
| Facility | | $30,764.10 | $30,764.10 | $30,764.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,646.82 / $24,480.41 / $24,480.41
| Facility | | $23,646.82 | $24,480.41 | $24,480.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,440.14 / $20,347.47 / $38,994.19
| Facility | | $14,440.14 | $20,347.47 | $38,994.19 |
- 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
- $14,440.14 / $20,347.47 / $37,364.96
| Facility | | $14,440.14 | $20,347.47 | $37,364.96 |