- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51,020.30 / $51,020.30 / $51,020.30
| Facility | | $51,020.30 | $51,020.30 | $51,020.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39,216.83 / $40,599.29 / $40,599.29
| Facility | | $39,216.83 | $40,599.29 | $40,599.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,948.10 / $33,745.05 / $54,205.57
| Facility | | $23,948.10 | $33,745.05 | $54,205.57 |
- 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
- $23,948.10 / $33,745.05 / $61,967.52
| Facility | | $23,948.10 | $33,745.05 | $61,967.52 |