- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,945.20 / $31,945.20 / $31,945.20
| Facility | | $31,945.20 | $31,945.20 | $31,945.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,554.70 / $25,420.29 / $25,420.29
| Facility | | $24,554.70 | $25,420.29 | $25,420.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,994.54 / $21,128.67 / $38,698.75
| Facility | | $14,994.54 | $21,128.67 | $38,698.75 |
- 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
- $14,994.54 / $21,128.67 / $38,799.51
| Facility | | $14,994.54 | $21,128.67 | $38,799.51 |