- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,567.60 / $23,567.60 / $23,567.60
| Facility | | $23,567.60 | $23,567.60 | $23,567.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,115.29 / $18,753.88 / $18,753.88
| Facility | | $18,115.29 | $18,753.88 | $18,753.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,062.26 / $15,587.73 / $29,141.90
| Facility | | $11,062.26 | $15,587.73 | $29,141.90 |
- 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
- $11,062.26 / $15,587.73 / $28,624.44
| Facility | | $11,062.26 | $15,587.73 | $28,624.44 |