- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,052.50 / $25,052.50 / $25,052.50
| Facility | | $25,052.50 | $25,052.50 | $25,052.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,256.61 / $19,935.43 / $19,935.43
| Facility | | $19,256.61 | $19,935.43 | $19,935.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,759.22 / $16,569.81 / $29,876.25
| Facility | | $11,759.22 | $16,569.81 | $29,876.25 |
- 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
- $11,759.22 / $16,569.81 / $30,427.87
| Facility | | $11,759.22 | $16,569.81 | $30,427.87 |