- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,276.60 / $23,276.60 / $23,276.60
| Facility | | $23,276.60 | $23,276.60 | $23,276.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,891.56 / $18,522.27 / $18,522.27
| Facility | | $17,891.56 | $18,522.27 | $18,522.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,925.64 / $15,395.22 / $27,458.01
| Facility | | $10,925.64 | $15,395.22 | $27,458.01 |
- 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
- $10,925.64 / $15,395.22 / $28,270.92
| Facility | | $10,925.64 | $15,395.22 | $28,270.92 |