- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,919.80 / $26,919.80 / $26,919.80
| Facility | | $26,919.80 | $26,919.80 | $26,919.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,691.91 / $21,421.34 / $21,421.34
| Facility | | $20,691.91 | $21,421.34 | $21,421.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,635.70 / $17,804.84 / $32,407.21
| Facility | | $12,635.70 | $17,804.84 | $32,407.21 |
- 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
- $12,635.70 / $17,804.84 / $32,695.83
| Facility | | $12,635.70 | $17,804.84 | $32,695.83 |