- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,000.70 / $24,000.70 / $24,000.70
| Facility | | $24,000.70 | $24,000.70 | $24,000.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,448.18 / $19,098.50 / $19,098.50
| Facility | | $18,448.18 | $19,098.50 | $19,098.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,265.54 / $15,874.17 / $26,926.88
| Facility | | $11,265.54 | $15,874.17 | $26,926.88 |
- 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
- $11,265.54 / $15,874.17 / $29,150.44
| Facility | | $11,265.54 | $15,874.17 | $29,150.44 |