- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37,084.50 / $37,084.50 / $37,084.50
| Facility | | $37,084.50 | $37,084.50 | $37,084.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,505.02 / $29,509.87 / $29,509.87
| Facility | | $28,505.02 | $29,509.87 | $29,509.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,406.84 / $24,527.82 / $45,313.06
| Facility | | $17,406.84 | $24,527.82 | $45,313.06 |
- 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
- $17,406.84 / $24,527.82 / $45,041.52
| Facility | | $17,406.84 | $24,527.82 | $45,041.52 |