- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,297.40 / $24,297.40 / $24,297.40
| Facility | | $24,297.40 | $24,297.40 | $24,297.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,676.22 / $19,334.59 / $19,334.59
| Facility | | $18,676.22 | $19,334.59 | $19,334.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,404.80 / $16,070.40 / $30,279.29
| Facility | | $11,404.80 | $16,070.40 | $30,279.29 |
- 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
- $11,404.80 / $16,070.40 / $29,510.78
| Facility | | $11,404.80 | $16,070.40 | $29,510.78 |