- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,648.10 / $27,648.10 / $27,648.10
| Facility | | $27,648.10 | $27,648.10 | $27,648.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,251.77 / $22,000.93 / $22,000.93
| Facility | | $21,251.77 | $22,000.93 | $22,000.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,977.58 / $18,286.59 / $31,660.90
| Facility | | $12,977.58 | $18,286.59 | $31,660.90 |
- 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
- $12,977.58 / $18,286.59 / $33,580.47
| Facility | | $12,977.58 | $18,286.59 | $33,580.47 |