- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,620.00 / $27,620.00 / $27,620.00
| Facility | | $27,620.00 | $27,620.00 | $27,620.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,230.15 / $21,978.55 / $21,978.55
| Facility | | $21,230.15 | $21,978.55 | $21,978.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,964.38 / $18,267.99 / $35,634.37
| Facility | | $12,964.38 | $18,267.99 | $35,634.37 |
- 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
- $12,964.38 / $18,267.99 / $33,546.32
| Facility | | $12,964.38 | $18,267.99 | $33,546.32 |