- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,110.70 / $23,110.70 / $23,110.70
| Facility | | $23,110.70 | $23,110.70 | $23,110.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,764.03 / $18,390.24 / $18,390.24
| Facility | | $17,764.03 | $18,390.24 | $18,390.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,847.76 / $15,285.48 / $29,305.85
| Facility | | $10,847.76 | $15,285.48 | $29,305.85 |
- 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
- $10,847.76 / $15,285.48 / $28,069.40
| Facility | | $10,847.76 | $15,285.48 | $28,069.40 |