- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,428.40 / $21,863.90 / $44,421.50
| Facility | | $11,428.40 | $21,863.90 | $44,421.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,420.01 / $33,420.01 / $35,508.15
| Facility | | $33,420.01 | $33,420.01 | $35,508.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,500.00 / $12,915.83 / $20,030.38
| Facility | | $7,500.00 | $12,915.83 | $20,030.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,500.00 / $12,696.58 / $35,508.15
| Facility | | $7,500.00 | $12,696.58 | $35,508.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,740.00 / $10,740.00 / $10,740.00
| Facility | | $10,740.00 | $10,740.00 | $10,740.00 |