- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,122.30 / $27,122.30 / $27,122.30
| Facility | | $27,122.30 | $27,122.30 | $27,122.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,847.55 / $21,582.46 / $21,582.46
| Facility | | $20,847.55 | $21,582.46 | $21,582.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,730.74 / $17,938.77 / $32,200.57
| Facility | | $12,730.74 | $17,938.77 | $32,200.57 |
- 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
- $12,730.74 / $17,938.77 / $32,941.75
| Facility | | $12,730.74 | $17,938.77 | $32,941.75 |