- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,248.70 / $22,248.70 / $22,248.70
| Facility | | $22,248.70 | $22,248.70 | $22,248.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,101.50 / $17,704.34 / $17,704.34
| Facility | | $17,101.50 | $17,704.34 | $17,704.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,443.18 / $14,715.39 / $27,748.33
| Facility | | $10,443.18 | $14,715.39 | $27,748.33 |
- 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
- $10,443.18 / $14,715.39 / $27,022.52
| Facility | | $10,443.18 | $14,715.39 | $27,022.52 |