- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37,928.10 / $37,928.10 / $37,928.10
| Facility | | $37,928.10 | $37,928.10 | $37,928.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,153.50 / $30,181.21 / $30,181.21
| Facility | | $29,153.50 | $30,181.21 | $30,181.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,802.84 / $25,085.82 / $44,684.59
| Facility | | $17,802.84 | $25,085.82 | $44,684.59 |
- 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
- $17,802.84 / $25,085.82 / $46,066.20
| Facility | | $17,802.84 | $25,085.82 | $46,066.20 |