- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,812.40 / $28,812.40 / $28,812.40
| Facility | | $28,812.40 | $28,812.40 | $28,812.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,146.67 / $22,927.38 / $22,927.38
| Facility | | $22,146.67 | $22,927.38 | $22,927.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,524.06 / $19,056.63 / $33,370.41
| Facility | | $13,524.06 | $19,056.63 | $33,370.41 |
- 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
- $13,524.06 / $19,056.63 / $34,994.53
| Facility | | $13,524.06 | $19,056.63 | $34,994.53 |