- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,931.60 / $24,931.60 / $24,931.60
| Facility | | $24,931.60 | $24,931.60 | $24,931.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,163.66 / $19,839.22 / $19,839.22
| Facility | | $19,163.66 | $19,839.22 | $19,839.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,702.46 / $16,489.83 / $29,852.34
| Facility | | $11,702.46 | $16,489.83 | $29,852.34 |
- 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
- $11,702.46 / $16,489.83 / $30,281.00
| Facility | | $11,702.46 | $16,489.83 | $30,281.00 |