- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36,496.69 / $36,496.69 / $36,496.69
| Facility | | $36,496.69 | $36,496.69 | $36,496.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,053.24 / $29,042.17 / $29,042.17
| Facility | | $28,053.24 | $29,042.17 | $29,042.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,130.96 / $24,139.08 / $43,600.13
| Facility | | $17,130.96 | $24,139.08 | $43,600.13 |
- 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
- $17,130.96 / $24,139.08 / $44,327.66
| Facility | | $17,130.96 | $24,139.08 | $44,327.66 |