- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45,376.30 / $45,376.30 / $45,376.30
| Facility | | $45,376.30 | $45,376.30 | $45,376.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,878.50 / $36,108.01 / $36,108.01
| Facility | | $34,878.50 | $36,108.01 | $36,108.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,298.86 / $30,012.03 / $54,979.21
| Facility | | $21,298.86 | $30,012.03 | $54,979.21 |
- 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
- $21,298.86 / $30,012.03 / $55,112.41
| Facility | | $21,298.86 | $30,012.03 | $55,112.41 |