- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,727.60 / $35,727.60 / $35,727.60
| Facility | | $35,727.60 | $35,727.60 | $35,727.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,462.05 / $28,430.13 / $28,430.13
| Facility | | $27,462.05 | $28,430.13 | $28,430.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,769.93 / $23,630.37 / $44,134.68
| Facility | | $16,769.93 | $23,630.37 | $44,134.68 |
- 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
- $16,769.93 / $23,630.37 / $43,393.49
| Facility | | $16,769.93 | $23,630.37 | $43,393.49 |