- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,444.80 / $25,444.80 / $25,444.80
| Facility | | $25,444.80 | $25,444.80 | $25,444.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,558.16 / $20,247.61 / $20,247.61
| Facility | | $19,558.16 | $20,247.61 | $20,247.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,943.36 / $16,829.28 / $31,052.93
| Facility | | $11,943.36 | $16,829.28 | $31,052.93 |
- 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
- $11,943.36 / $16,829.28 / $30,904.35
| Facility | | $11,943.36 | $16,829.28 | $30,904.35 |