- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,328.40 / $29,328.40 / $29,328.40
| Facility | | $29,328.40 | $29,328.40 | $29,328.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,543.33 / $23,338.02 / $23,338.02
| Facility | | $22,543.33 | $23,338.02 | $23,338.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,766.28 / $19,397.93 / $36,476.90
| Facility | | $13,766.28 | $19,397.93 | $36,476.90 |
- 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
- $13,766.28 / $19,397.93 / $35,621.29
| Facility | | $13,766.28 | $19,397.93 | $35,621.29 |