- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45,287.70 / $45,287.70 / $45,287.70
| Facility | | $45,287.70 | $45,287.70 | $45,287.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,810.41 / $36,037.53 / $36,037.53
| Facility | | $34,810.41 | $36,037.53 | $36,037.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,257.28 / $29,953.44 / $54,314.87
| Facility | | $21,257.28 | $29,953.44 | $54,314.87 |
- 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
- $21,257.28 / $29,953.44 / $55,004.82
| Facility | | $21,257.28 | $29,953.44 | $55,004.82 |