- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44,767.40 / $44,767.40 / $44,767.40
| Facility | | $44,767.40 | $44,767.40 | $44,767.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,410.51 / $35,623.54 / $35,623.54
| Facility | | $34,410.51 | $35,623.54 | $35,623.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,013.08 / $29,609.34 / $55,640.12
| Facility | | $21,013.08 | $29,609.34 | $55,640.12 |
- 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
- $21,013.08 / $29,609.34 / $54,372.94
| Facility | | $21,013.08 | $29,609.34 | $54,372.94 |