- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32,883.10 / $32,883.10 / $32,883.10
| Facility | | $32,883.10 | $32,883.10 | $32,883.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,275.59 / $26,166.60 / $26,166.60
| Facility | | $25,275.59 | $26,166.60 | $26,166.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,434.76 / $21,748.98 / $39,422.86
| Facility | | $15,434.76 | $21,748.98 | $39,422.86 |
- 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
- $15,434.76 / $21,748.98 / $39,938.61
| Facility | | $15,434.76 | $21,748.98 | $39,938.61 |