- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,957.10 / $23,957.10 / $23,957.10
| Facility | | $23,957.10 | $23,957.10 | $23,957.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,414.66 / $19,063.82 / $19,063.82
| Facility | | $18,414.66 | $19,063.82 | $19,063.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,245.08 / $15,845.34 / $27,374.33
| Facility | | $11,245.08 | $15,845.34 | $27,374.33 |
- 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
- $11,245.08 / $15,845.34 / $29,097.50
| Facility | | $11,245.08 | $15,845.34 | $29,097.50 |