- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55,005.20 / $55,005.20 / $55,005.20
| Facility | | $55,005.20 | $55,005.20 | $55,005.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42,279.82 / $43,770.25 / $43,770.25
| Facility | | $42,279.82 | $43,770.25 | $43,770.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,818.54 / $36,380.67 / $64,925.43
| Facility | | $25,818.54 | $36,380.67 | $64,925.43 |
- 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
- $28,607.72 / $40,292.57 / $66,940.42
| Facility | | $28,607.72 | $40,292.57 | $66,940.42 |