- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,267.60 / $25,267.60 / $25,267.60
| Facility | | $25,267.60 | $25,267.60 | $25,267.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,421.98 / $20,106.63 / $20,106.63
| Facility | | $19,421.98 | $20,106.63 | $20,106.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,860.20 / $16,712.09 / $32,599.38
| Facility | | $11,860.20 | $16,712.09 | $32,599.38 |
- 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
- $11,860.20 / $16,712.09 / $30,689.17
| Facility | | $11,860.20 | $16,712.09 | $30,689.17 |