- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59,008.40 / $59,008.40 / $59,008.40
| Facility | | $59,008.40 | $59,008.40 | $59,008.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45,356.85 / $46,955.76 / $46,955.76
| Facility | | $45,356.85 | $46,955.76 | $46,955.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,697.56 / $39,028.37 / $75,664.08
| Facility | | $27,697.56 | $39,028.37 | $75,664.08 |
- 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
- $27,697.56 / $39,028.37 / $71,669.53
| Facility | | $27,697.56 | $39,028.37 | $71,669.53 |