- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,852.00 / $27,852.00 / $27,852.00
| Facility | | $27,852.00 | $27,852.00 | $27,852.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,408.49 / $22,163.17 / $22,163.17
| Facility | | $21,408.49 | $22,163.17 | $22,163.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,073.28 / $18,421.43 / $33,394.32
| Facility | | $13,073.28 | $18,421.43 | $33,394.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.00 / $950.00 / $950.00
| Facility | | $950.00 | $950.00 | $950.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,073.28 / $18,421.43 / $33,828.10
| Facility | | $13,073.28 | $18,421.43 | $33,828.10 |