- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,054.50 / $28,054.50 / $28,054.50
| Facility | | $28,054.50 | $28,054.50 | $28,054.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,564.12 / $22,324.29 / $22,324.29
| Facility | | $21,564.12 | $22,324.29 | $22,324.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,168.32 / $18,555.36 / $34,448.03
| Facility | | $13,168.32 | $18,555.36 | $34,448.03 |
- 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
- $13,168.32 / $18,555.36 / $34,074.03
| Facility | | $13,168.32 | $18,555.36 | $34,074.03 |