- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,745.70 / $25,745.70 / $25,745.70
| Facility | | $25,745.70 | $25,745.70 | $25,745.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,789.45 / $20,487.06 / $20,487.06
| Facility | | $19,789.45 | $20,487.06 | $20,487.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,084.60 / $17,028.30 / $32,239.85
| Facility | | $12,084.60 | $17,028.30 | $32,239.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.00 / $950.00 / $950.00
| Facility | | $950.00 | $950.00 | $950.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,084.60 / $17,028.30 / $31,269.82
| Facility | | $12,084.60 | $17,028.30 | $31,269.82 |