- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,707.00 / $33,707.00 / $33,707.00
| Facility | | $33,707.00 | $33,707.00 | $33,707.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,908.94 / $26,822.27 / $26,822.27
| Facility | | $25,908.94 | $26,822.27 | $26,822.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,821.52 / $22,293.96 / $40,367.26
| Facility | | $15,821.52 | $22,293.96 | $40,367.26 |
- 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
- $15,821.52 / $22,293.96 / $40,939.37
| Facility | | $15,821.52 | $22,293.96 | $40,939.37 |