- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,731.60 / $25,731.60 / $25,731.60
| Facility | | $25,731.60 | $25,731.60 | $25,731.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,778.64 / $20,475.87 / $20,475.87
| Facility | | $19,778.64 | $20,475.87 | $20,475.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,078.00 / $17,019.00 / $31,220.29
| Facility | | $12,078.00 | $17,019.00 | $31,220.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,450.00 / $1,450.00 / $1,450.00
| Facility | | $1,450.00 | $1,450.00 | $1,450.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,078.00 / $17,019.00 / $31,252.74
| Facility | | $12,078.00 | $17,019.00 | $31,252.74 |