- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,079.70 / $23,079.70 / $23,079.70
| Facility | | $23,079.70 | $23,079.70 | $23,079.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,740.25 / $18,365.62 / $18,365.62
| Facility | | $17,740.25 | $18,365.62 | $18,365.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,833.24 / $15,265.02 / $26,732.19
| Facility | | $10,833.24 | $15,265.02 | $26,732.19 |
- 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
- $10,833.24 / $15,265.02 / $28,031.83
| Facility | | $10,833.24 | $15,265.02 | $28,031.83 |