- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,058.80 / $33,058.80 / $33,058.80
| Facility | | $33,058.80 | $33,058.80 | $33,058.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,410.69 / $26,306.46 / $26,306.46
| Facility | | $25,410.69 | $26,306.46 | $26,306.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,517.26 / $21,865.23 / $38,538.21
| Facility | | $15,517.26 | $21,865.23 | $38,538.21 |
- 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
- $15,517.26 / $21,865.23 / $40,152.08
| Facility | | $15,517.26 | $21,865.23 | $40,152.08 |