- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,330.10 / $28,330.10 / $28,330.10
| Facility | | $28,330.10 | $28,330.10 | $28,330.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,775.96 / $22,543.60 / $22,543.60
| Facility | | $21,775.96 | $22,543.60 | $22,543.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,297.68 / $18,737.64 / $23,875.38
| Facility | | $13,297.68 | $18,737.64 | $23,875.38 |
- 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
- $13,297.68 / $18,737.64 / $34,408.75
| Facility | | $13,297.68 | $18,737.64 | $34,408.75 |