- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,718.50 / $43,718.50 / $43,718.50
| Facility | | $43,718.50 | $43,718.50 | $43,718.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,604.23 / $34,788.83 / $34,788.83
| Facility | | $33,604.23 | $34,788.83 | $34,788.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,520.72 / $28,915.56 / $52,234.77
| Facility | | $20,520.72 | $28,915.56 | $52,234.77 |
- 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
- $20,520.72 / $28,915.56 / $53,098.92
| Facility | | $20,520.72 | $28,915.56 | $53,098.92 |