- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,872.50 / $24,872.50 / $24,872.50
| Facility | | $24,872.50 | $24,872.50 | $24,872.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,118.27 / $19,792.22 / $19,792.22
| Facility | | $19,118.27 | $19,792.22 | $19,792.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,674.74 / $16,450.77 / $32,089.61
| Facility | | $11,674.74 | $16,450.77 | $32,089.61 |
- 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
- $11,674.74 / $16,450.77 / $30,209.27
| Facility | | $11,674.74 | $16,450.77 | $30,209.27 |