- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,282.80 / $26,282.80 / $26,282.80
| Facility | | $26,282.80 | $26,282.80 | $26,282.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,202.31 / $20,914.48 / $20,914.48
| Facility | | $20,202.31 | $20,914.48 | $20,914.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,336.72 / $17,383.56 / $29,971.89
| Facility | | $12,336.72 | $17,383.56 | $29,971.89 |
- 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
- $12,336.72 / $17,383.56 / $31,922.20
| Facility | | $12,336.72 | $17,383.56 | $31,922.20 |