- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,511.50 / $28,511.50 / $28,511.50
| Facility | | $28,511.50 | $28,511.50 | $28,511.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,915.38 / $22,687.94 / $22,687.94
| Facility | | $21,915.38 | $22,687.94 | $22,687.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,382.82 / $18,857.61 / $33,375.54
| Facility | | $13,382.82 | $18,857.61 | $33,375.54 |
- 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
- $13,382.82 / $18,857.61 / $34,629.06
| Facility | | $13,382.82 | $18,857.61 | $34,629.06 |