- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37,271.50 / $37,271.50 / $37,271.50
| Facility | | $37,271.50 | $37,271.50 | $37,271.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,648.77 / $29,658.68 / $29,658.68
| Facility | | $28,648.77 | $29,658.68 | $29,658.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,494.62 / $24,651.51 / $45,475.30
| Facility | | $17,494.62 | $24,651.51 | $45,475.30 |
- 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
- $17,494.62 / $24,651.51 / $45,268.65
| Facility | | $17,494.62 | $24,651.51 | $45,268.65 |