- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36,453.10 / $36,453.10 / $36,453.10
| Facility | | $36,453.10 | $36,453.10 | $36,453.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,019.74 / $29,007.48 / $29,007.48
| Facility | | $28,019.74 | $29,007.48 | $29,007.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,110.50 / $24,110.25 / $43,613.80
| Facility | | $17,110.50 | $24,110.25 | $43,613.80 |
- 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
- $17,110.50 / $24,110.25 / $44,274.72
| Facility | | $17,110.50 | $24,110.25 | $44,274.72 |