- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,590.50 / $27,590.50 / $27,590.50
| Facility | | $27,590.50 | $27,590.50 | $27,590.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,207.46 / $21,955.06 / $21,955.06
| Facility | | $21,207.46 | $21,955.06 | $21,955.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,950.52 / $18,248.46 / $32,863.19
| Facility | | $12,950.52 | $18,248.46 | $32,863.19 |
- 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
- $12,950.52 / $18,248.46 / $33,510.44
| Facility | | $12,950.52 | $18,248.46 | $33,510.44 |