- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50,910.70 / $50,910.70 / $50,910.70
| Facility | | $50,910.70 | $50,910.70 | $50,910.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39,132.53 / $40,512.01 / $40,512.01
| Facility | | $39,132.53 | $40,512.01 | $40,512.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,896.62 / $33,672.51 / $59,238.46
| Facility | | $23,896.62 | $33,672.51 | $59,238.46 |
- 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
- $23,896.62 / $33,672.51 / $61,834.31
| Facility | | $23,896.62 | $33,672.51 | $61,834.31 |