- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,095.30 / $28,095.30 / $28,095.30
| Facility | | $28,095.30 | $28,095.30 | $28,095.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,595.46 / $22,356.74 / $22,356.74
| Facility | | $21,595.46 | $22,356.74 | $22,356.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,187.46 / $18,582.33 / $34,123.55
| Facility | | $13,187.46 | $18,582.33 | $34,123.55 |
- 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
- $13,187.46 / $18,582.33 / $34,123.55
| Facility | | $13,187.46 | $18,582.33 | $34,123.55 |