- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,061.00 / $21,161.10 / $42,993.60
| Facility | | $11,061.00 | $21,161.10 | $42,993.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32,345.72 / $32,345.72 / $34,366.73
| Facility | | $32,345.72 | $32,345.72 | $34,366.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,500.00 / $12,500.64 / $20,057.36
| Facility | | $7,500.00 | $12,500.64 | $20,057.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,500.00 / $12,713.68 / $34,366.73
| Facility | | $7,500.00 | $12,713.68 | $34,366.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,394.00 / $10,394.00 / $10,394.00
| Facility | | $10,394.00 | $10,394.00 | $10,394.00 |