- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,856.60 / $31,856.60 / $31,856.60
| Facility | | $31,856.60 | $31,856.60 | $31,856.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,486.60 / $25,349.80 / $25,349.80
| Facility | | $24,486.60 | $25,349.80 | $25,349.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,952.96 / $21,070.08 / $37,561.35
| Facility | | $14,952.96 | $21,070.08 | $37,561.35 |
- 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
- $14,952.96 / $21,070.08 / $38,691.92
| Facility | | $14,952.96 | $21,070.08 | $38,691.92 |