- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,660.10 / $35,660.10 / $35,660.10
| Facility | | $35,660.10 | $35,660.10 | $35,660.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,410.17 / $28,376.42 / $28,376.42
| Facility | | $27,410.17 | $28,376.42 | $28,376.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,738.25 / $23,585.73 / $41,004.28
| Facility | | $16,738.25 | $23,585.73 | $41,004.28 |
- 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
- $16,738.25 / $23,585.73 / $43,311.52
| Facility | | $16,738.25 | $23,585.73 | $43,311.52 |