- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,150.40 / $27,150.40 / $27,150.40
| Facility | | $27,150.40 | $27,150.40 | $27,150.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,869.16 / $21,604.84 / $21,604.84
| Facility | | $20,869.16 | $21,604.84 | $21,604.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,743.94 / $17,957.37 / $34,405.33
| Facility | | $12,743.94 | $17,957.37 | $34,405.33 |
- 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
- $12,743.94 / $17,957.37 / $32,975.91
| Facility | | $12,743.94 | $17,957.37 | $32,975.91 |