- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52,550.20 / $52,550.20 / $52,550.20
| Facility | | $52,550.20 | $52,550.20 | $52,550.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40,392.74 / $41,816.65 / $41,816.65
| Facility | | $40,392.74 | $41,816.65 | $41,816.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,666.18 / $34,756.89 / $61,207.55
| Facility | | $24,666.18 | $34,756.89 | $61,207.55 |
- 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
- $24,666.18 / $34,756.89 / $63,825.61
| Facility | | $24,666.18 | $34,756.89 | $63,825.61 |