- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,441.10 / $23,441.10 / $23,441.10
| Facility | | $23,441.10 | $23,441.10 | $23,441.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,018.02 / $18,653.18 / $18,653.18
| Facility | | $18,018.02 | $18,653.18 | $18,653.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,002.86 / $15,504.03 / $30,000.92
| Facility | | $11,002.86 | $15,504.03 | $30,000.92 |
- 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
- $11,002.86 / $15,504.03 / $28,470.73
| Facility | | $11,002.86 | $15,504.03 | $28,470.73 |