- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,962.00 / $26,962.00 / $26,962.00
| Facility | | $26,962.00 | $26,962.00 | $26,962.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,724.34 / $21,454.91 / $21,454.91
| Facility | | $20,724.34 | $21,454.91 | $21,454.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,655.50 / $17,832.75 / $29,415.15
| Facility | | $12,655.50 | $17,832.75 | $29,415.15 |
- 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
- $12,655.50 / $17,832.75 / $32,747.07
| Facility | | $12,655.50 | $17,832.75 | $32,747.07 |