- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,432.50 / $29,432.50 / $29,432.50
| Facility | | $29,432.50 | $29,432.50 | $29,432.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,623.31 / $23,420.81 / $23,420.81
| Facility | | $22,623.31 | $23,420.81 | $23,420.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,815.12 / $19,466.75 / $36,620.36
| Facility | | $13,815.12 | $19,466.75 | $36,620.36 |
- 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
- $13,815.12 / $19,466.75 / $35,747.67
| Facility | | $13,815.12 | $19,466.75 | $35,747.67 |