- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,201.40 / $20,201.40 / $20,201.40
| Facility | | $20,201.40 | $20,201.40 | $20,201.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,527.85 / $16,075.24 / $16,075.24
| Facility | | $15,527.85 | $16,075.24 | $16,075.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,482.21 / $13,361.31 / $24,870.69
| Facility | | $9,482.21 | $13,361.31 | $24,870.69 |
- 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
- $10,506.59 / $15,020.70 / $24,584.81
| Facility | | $10,506.59 | $15,020.70 | $24,584.81 |