- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52,555.80 / $52,555.80 / $52,555.80
| Facility | | $52,555.80 | $52,555.80 | $52,555.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40,397.06 / $41,821.12 / $41,821.12
| Facility | | $40,397.06 | $41,821.12 | $41,821.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,668.82 / $34,760.61 / $65,755.42
| Facility | | $24,668.82 | $34,760.61 | $65,755.42 |
- 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
- $24,668.82 / $34,760.61 / $63,832.44
| Facility | | $24,668.82 | $34,760.61 | $63,832.44 |