- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37,402.30 / $37,402.30 / $37,402.30
| Facility | | $37,402.30 | $37,402.30 | $37,402.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,749.28 / $29,762.74 / $29,762.74
| Facility | | $28,749.28 | $29,762.74 | $29,762.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,556.00 / $24,738.00 / $48,255.06
| Facility | | $17,556.00 | $24,738.00 | $48,255.06 |
- 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
- $17,556.00 / $24,738.00 / $45,427.48
| Facility | | $17,556.00 | $24,738.00 | $45,427.48 |