- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,512.40 / $30,512.40 / $30,512.40
| Facility | | $30,512.40 | $30,512.40 | $30,512.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,453.36 / $24,280.13 / $24,280.13
| Facility | | $23,453.36 | $24,280.13 | $24,280.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,322.00 / $20,181.00 / $39,365.97
| Facility | | $14,322.00 | $20,181.00 | $39,365.97 |
- 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
- $14,322.00 / $20,181.00 / $37,059.26
| Facility | | $14,322.00 | $20,181.00 | $37,059.26 |