- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,703.50 / $25,703.50 / $25,703.50
| Facility | | $25,703.50 | $25,703.50 | $25,703.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,757.02 / $20,453.49 / $20,453.49
| Facility | | $19,757.02 | $20,453.49 | $20,453.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,064.80 / $17,000.40 / $31,051.22
| Facility | | $12,064.80 | $17,000.40 | $31,051.22 |
- 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
- $13,368.16 / $18,828.40 / $31,280.74
| Facility | | $13,368.16 | $18,828.40 | $31,280.74 |