- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41,354.80 / $41,354.80 / $41,354.80
| Facility | | $41,354.80 | $41,354.80 | $41,354.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,787.41 / $32,907.97 / $32,907.97
| Facility | | $31,787.41 | $32,907.97 | $32,907.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,411.25 / $27,352.23 / $51,408.20
| Facility | | $19,411.25 | $27,352.23 | $51,408.20 |
- 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
- $19,411.25 / $27,352.23 / $50,228.11
| Facility | | $19,411.25 | $27,352.23 | $50,228.11 |