- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,364.60 / $25,364.60 / $25,364.60
| Facility | | $25,364.60 | $25,364.60 | $25,364.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,496.55 / $20,183.84 / $20,183.84
| Facility | | $19,496.55 | $20,183.84 | $20,183.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,905.74 / $16,776.27 / $32,724.55
| Facility | | $11,905.74 | $16,776.27 | $32,724.55 |
- 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
- $11,905.74 / $16,776.27 / $30,807.00
| Facility | | $11,905.74 | $16,776.27 | $30,807.00 |