- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,124.80 / $28,124.80 / $28,124.80
| Facility | | $28,124.80 | $28,124.80 | $28,124.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,618.16 / $22,380.24 / $22,380.24
| Facility | | $21,618.16 | $22,380.24 | $22,380.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,201.32 / $18,601.86 / $33,676.11
| Facility | | $13,201.32 | $18,601.86 | $33,676.11 |
- 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
- $13,201.32 / $18,601.86 / $34,159.42
| Facility | | $13,201.32 | $18,601.86 | $34,159.42 |