- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $49,036.30 / $49,036.30 / $49,036.30
| Facility | | $49,036.30 | $49,036.30 | $49,036.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37,691.82 / $39,020.51 / $39,020.51
| Facility | | $37,691.82 | $39,020.51 | $39,020.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,016.84 / $32,432.82 / $63,264.92
| Facility | | $23,016.84 | $32,432.82 | $63,264.92 |
- 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
- $23,016.84 / $32,432.82 / $59,557.82
| Facility | | $23,016.84 | $32,432.82 | $59,557.82 |