- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,047.80 / $43,047.80 / $43,047.80
| Facility | | $43,047.80 | $43,047.80 | $43,047.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,088.69 / $34,255.12 / $34,255.12
| Facility | | $33,088.69 | $34,255.12 | $34,255.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,205.90 / $28,471.95 / $53,276.53
| Facility | | $20,205.90 | $28,471.95 | $53,276.53 |
- 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
- $20,205.90 / $28,471.95 / $52,284.30
| Facility | | $20,205.90 | $28,471.95 | $52,284.30 |