- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,208.60 / $25,208.60 / $25,208.60
| Facility | | $25,208.60 | $25,208.60 | $25,208.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,376.58 / $20,059.64 / $20,059.64
| Facility | | $19,376.58 | $20,059.64 | $20,059.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,832.48 / $16,673.04 / $29,971.89
| Facility | | $11,832.48 | $16,673.04 | $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
- $11,832.48 / $16,673.04 / $30,617.44
| Facility | | $11,832.48 | $16,673.04 | $30,617.44 |