- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,650.40 / $29,650.40 / $29,650.40
| Facility | | $29,650.40 | $29,650.40 | $29,650.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,790.83 / $23,594.24 / $23,594.24
| Facility | | $22,790.83 | $23,594.24 | $23,594.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,917.42 / $19,610.91 / $36,073.86
| Facility | | $13,917.42 | $19,610.91 | $36,073.86 |
- 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
- $13,917.42 / $19,610.91 / $36,012.37
| Facility | | $13,917.42 | $19,610.91 | $36,012.37 |