- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,555.19 / $33,555.19 / $33,555.19
| Facility | | $33,555.19 | $33,555.19 | $33,555.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,792.21 / $26,701.43 / $26,701.43
| Facility | | $25,792.21 | $26,701.43 | $26,701.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,750.24 / $22,193.52 / $40,585.87
| Facility | | $15,750.24 | $22,193.52 | $40,585.87 |
- 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
- $15,750.24 / $22,193.52 / $40,754.94
| Facility | | $15,750.24 | $22,193.52 | $40,754.94 |