- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50,045.90 / $50,045.90 / $50,045.90
| Facility | | $50,045.90 | $50,045.90 | $50,045.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,467.83 / $39,823.89 / $39,823.89
| Facility | | $38,467.83 | $39,823.89 | $39,823.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,490.72 / $33,100.56 / $63,905.88
| Facility | | $23,490.72 | $33,100.56 | $63,905.88 |
- 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
- $23,490.72 / $33,100.56 / $60,784.02
| Facility | | $23,490.72 | $33,100.56 | $60,784.02 |