- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44,894.00 / $44,894.00 / $44,894.00
| Facility | | $44,894.00 | $44,894.00 | $44,894.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,507.78 / $35,724.24 / $35,724.24
| Facility | | $34,507.78 | $35,724.24 | $35,724.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,072.48 / $29,693.04 / $57,920.58
| Facility | | $21,072.48 | $29,693.04 | $57,920.58 |
- 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
- $21,072.48 / $29,693.04 / $54,526.64
| Facility | | $21,072.48 | $29,693.04 | $54,526.64 |