- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,246.80 / $24,246.80 / $24,246.80
| Facility | | $24,246.80 | $24,246.80 | $24,246.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,637.32 / $19,294.31 / $19,294.31
| Facility | | $18,637.32 | $19,294.31 | $19,294.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,381.04 / $16,036.92 / $28,054.03
| Facility | | $11,381.04 | $16,036.92 | $28,054.03 |
- 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
- $11,381.04 / $16,036.92 / $29,449.30
| Facility | | $11,381.04 | $16,036.92 | $29,449.30 |