- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,098.30 / $38,098.30 / $38,098.30
| Facility | | $38,098.30 | $38,098.30 | $38,098.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,284.28 / $30,316.60 / $30,316.60
| Facility | | $29,284.28 | $30,316.60 | $30,316.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,882.70 / $25,198.35 / $45,617.05
| Facility | | $17,882.70 | $25,198.35 | $45,617.05 |
- 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
- $17,882.70 / $25,198.35 / $46,272.84
| Facility | | $17,882.70 | $25,198.35 | $46,272.84 |