- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50,210.40 / $50,210.40 / $50,210.40
| Facility | | $50,210.40 | $50,210.40 | $50,210.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,594.29 / $39,954.80 / $39,954.80
| Facility | | $38,594.29 | $39,954.80 | $39,954.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,567.94 / $33,209.37 / $61,880.43
| Facility | | $23,567.94 | $33,209.37 | $61,880.43 |
- 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
- $23,567.94 / $33,209.37 / $60,983.83
| Facility | | $23,567.94 | $33,209.37 | $60,983.83 |