- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45,410.00 / $45,410.00 / $45,410.00
| Facility | | $45,410.00 | $45,410.00 | $45,410.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,904.44 / $36,134.87 / $36,134.87
| Facility | | $34,904.44 | $36,134.87 | $36,134.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,314.70 / $30,034.35 / $52,453.37
| Facility | | $21,314.70 | $30,034.35 | $52,453.37 |
- 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
- $21,314.70 / $30,034.35 / $55,153.40
| Facility | | $21,314.70 | $30,034.35 | $55,153.40 |