- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,643.00 / $25,643.00 / $25,643.00
| Facility | | $25,643.00 | $25,643.00 | $25,643.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,710.55 / $20,405.38 / $20,405.38
| Facility | | $19,710.55 | $20,405.38 | $20,405.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,036.42 / $16,960.41 / $29,649.12
| Facility | | $12,036.42 | $16,960.41 | $29,649.12 |
- 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
- $12,036.42 / $16,960.41 / $31,145.15
| Facility | | $12,036.42 | $16,960.41 | $31,145.15 |