- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,818.90 / $30,818.90 / $30,818.90
| Facility | | $30,818.90 | $30,818.90 | $30,818.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,688.97 / $24,524.05 / $24,524.05
| Facility | | $23,688.97 | $24,524.05 | $24,524.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,465.88 / $20,383.74 / $38,920.76
| Facility | | $14,465.88 | $20,383.74 | $38,920.76 |
- 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
- $14,465.88 / $20,383.74 / $37,431.56
| Facility | | $14,465.88 | $20,383.74 | $37,431.56 |