- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,145.80 / $23,145.80 / $23,145.80
| Facility | | $23,145.80 | $23,145.80 | $23,145.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,791.05 / $18,418.21 / $18,418.21
| Facility | | $17,791.05 | $18,418.21 | $18,418.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,864.26 / $15,308.73 / $28,303.37
| Facility | | $10,864.26 | $15,308.73 | $28,303.37 |
- 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
- $10,864.26 / $15,308.73 / $28,112.10
| Facility | | $10,864.26 | $15,308.73 | $28,112.10 |