- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,582.30 / $26,582.30 / $26,582.30
| Facility | | $26,582.30 | $26,582.30 | $26,582.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,432.52 / $21,152.80 / $21,152.80
| Facility | | $20,432.52 | $21,152.80 | $21,152.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,477.30 / $17,581.65 / $31,688.23
| Facility | | $12,477.30 | $17,581.65 | $31,688.23 |
- 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
- $12,477.30 / $17,581.65 / $32,285.96
| Facility | | $12,477.30 | $17,581.65 | $32,285.96 |