- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46,290.20 / $46,290.20 / $46,290.20
| Facility | | $46,290.20 | $46,290.20 | $46,290.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,581.01 / $36,835.31 / $36,835.31
| Facility | | $35,581.01 | $36,835.31 | $36,835.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,727.86 / $30,616.53 / $56,714.33
| Facility | | $21,727.86 | $30,616.53 | $56,714.33 |
- 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
- $21,727.86 / $30,616.53 / $56,222.48
| Facility | | $21,727.86 | $30,616.53 | $56,222.48 |