- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,799.10 / $25,799.10 / $25,799.10
| Facility | | $25,799.10 | $25,799.10 | $25,799.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,830.52 / $20,529.58 / $20,529.58
| Facility | | $19,830.52 | $20,529.58 | $20,529.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,109.68 / $17,063.64 / $31,196.38
| Facility | | $12,109.68 | $17,063.64 | $31,196.38 |
- 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
- $12,109.68 / $17,063.64 / $31,334.71
| Facility | | $12,109.68 | $17,063.64 | $31,334.71 |