- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50,093.70 / $50,093.70 / $50,093.70
| Facility | | $50,093.70 | $50,093.70 | $50,093.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,504.58 / $39,861.93 / $39,861.93
| Facility | | $38,504.58 | $39,861.93 | $39,861.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,513.16 / $33,132.18 / $59,837.90
| Facility | | $23,513.16 | $33,132.18 | $59,837.90 |
- 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
- $26,053.29 / $37,246.98 / $60,963.21
| Facility | | $26,053.29 | $37,246.98 | $60,963.21 |