- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,607.50 / $21,607.50 / $21,607.50
| Facility | | $21,607.50 | $21,607.50 | $21,607.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,608.65 / $17,194.14 / $17,194.14
| Facility | | $16,608.65 | $17,194.14 | $17,194.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,142.21 / $14,291.31 / $25,492.33
| Facility | | $10,142.21 | $14,291.31 | $25,492.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,450.00 / $1,450.00 / $1,450.00
| Facility | | $1,450.00 | $1,450.00 | $1,450.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,237.89 / $16,066.20 / $26,296.01
| Facility | | $11,237.89 | $16,066.20 | $26,296.01 |