- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45,536.60 / $45,536.60 / $45,536.60
| Facility | | $45,536.60 | $45,536.60 | $45,536.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,001.71 / $36,235.58 / $36,235.58
| Facility | | $35,001.71 | $36,235.58 | $36,235.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,374.10 / $30,118.05 / $55,664.03
| Facility | | $21,374.10 | $30,118.05 | $55,664.03 |
- 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
- $21,374.10 / $30,118.05 / $55,307.10
| Facility | | $21,374.10 | $30,118.05 | $55,307.10 |