- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32,721.40 / $32,721.40 / $32,721.40
| Facility | | $32,721.40 | $32,721.40 | $32,721.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,151.30 / $26,037.92 / $26,037.92
| Facility | | $25,151.30 | $26,037.92 | $26,037.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,358.86 / $21,642.03 / $38,375.97
| Facility | | $15,358.86 | $21,642.03 | $38,375.97 |
- 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
- $15,358.86 / $21,642.03 / $39,742.21
| Facility | | $15,358.86 | $21,642.03 | $39,742.21 |