- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,072.30 / $30,072.30 / $30,072.30
| Facility | | $30,072.30 | $30,072.30 | $30,072.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,115.07 / $23,929.91 / $23,929.91
| Facility | | $23,115.07 | $23,929.91 | $23,929.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,115.42 / $19,889.91 / $36,058.49
| Facility | | $14,115.42 | $19,889.91 | $36,058.49 |
- 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
- $14,115.42 / $19,889.91 / $36,524.72
| Facility | | $14,115.42 | $19,889.91 | $36,524.72 |