- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,458.70 / $31,458.70 / $31,458.70
| Facility | | $31,458.70 | $31,458.70 | $31,458.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,180.74 / $25,033.15 / $25,033.15
| Facility | | $24,180.74 | $25,033.15 | $25,033.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,766.18 / $20,806.89 / $38,567.25
| Facility | | $14,766.18 | $20,806.89 | $38,567.25 |
- 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
- $14,766.18 / $20,806.89 / $38,208.61
| Facility | | $14,766.18 | $20,806.89 | $38,208.61 |