- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,045.30 / $31,045.30 / $31,045.30
| Facility | | $31,045.30 | $31,045.30 | $31,045.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,862.98 / $24,704.19 / $24,704.19
| Facility | | $23,862.98 | $24,704.19 | $24,704.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,572.14 / $20,533.47 / $39,113.74
| Facility | | $14,572.14 | $20,533.47 | $39,113.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.00 / $950.00 / $950.00
| Facility | | $950.00 | $950.00 | $950.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,572.14 / $20,533.47 / $37,706.51
| Facility | | $14,572.14 | $20,533.47 | $37,706.51 |