- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,730.30 / $26,267.70 / $53,368.90
| Facility | | $13,730.30 | $26,267.70 | $53,368.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40,151.50 / $40,151.50 / $42,660.23
| Facility | | $40,151.50 | $40,151.50 | $42,660.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,500.00 / $15,517.35 / $24,529.55
| Facility | | $7,500.00 | $15,517.35 | $24,529.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,500.00 / $15,548.45 / $42,660.23
| Facility | | $7,500.00 | $15,548.45 | $42,660.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,903.00 / $12,903.00 / $12,903.00
| Facility | | $12,903.00 | $12,903.00 | $12,903.00 |