- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,825.80 / $25,825.80 / $25,825.80
| Facility | | $25,825.80 | $25,825.80 | $25,825.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,851.05 / $20,550.84 / $20,550.84
| Facility | | $19,851.05 | $20,550.84 | $20,550.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,122.22 / $17,081.31 / $31,160.52
| Facility | | $12,122.22 | $17,081.31 | $31,160.52 |
- 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
- $12,122.22 / $17,081.31 / $31,367.16
| Facility | | $12,122.22 | $17,081.31 | $31,367.16 |