- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,596.90 / $24,596.90 / $24,596.90
| Facility | | $24,596.90 | $24,596.90 | $24,596.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,906.43 / $19,572.91 / $19,572.91
| Facility | | $18,906.43 | $19,572.91 | $19,572.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,545.38 / $16,268.49 / $28,132.59
| Facility | | $11,545.38 | $16,268.49 | $28,132.59 |
- 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
- $11,545.38 / $16,268.49 / $29,874.55
| Facility | | $11,545.38 | $16,268.49 | $29,874.55 |