- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,838.80 / $24,838.80 / $24,838.80
| Facility | | $24,838.80 | $24,838.80 | $24,838.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,092.33 / $19,765.37 / $19,765.37
| Facility | | $19,092.33 | $19,765.37 | $19,765.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,658.90 / $16,428.45 / $31,852.18
| Facility | | $11,658.90 | $16,428.45 | $31,852.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.00 / $950.00 / $950.00
| Facility | | $950.00 | $950.00 | $950.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,658.90 / $16,428.45 / $30,168.29
| Facility | | $11,658.90 | $16,428.45 | $30,168.29 |