- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,795.80 / $43,795.80 / $43,795.80
| Facility | | $43,795.80 | $43,795.80 | $43,795.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,663.68 / $34,850.37 / $34,850.37
| Facility | | $33,663.68 | $34,850.37 | $34,850.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,557.02 / $28,966.71 / $50,356.19
| Facility | | $20,557.02 | $28,966.71 | $50,356.19 |
- 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
- $20,557.02 / $28,966.71 / $53,192.85
| Facility | | $20,557.02 | $28,966.71 | $53,192.85 |