- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63,931.10 / $63,931.10 / $63,931.10
| Facility | | $63,931.10 | $63,931.10 | $63,931.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $49,140.73 / $50,873.03 / $50,873.03
| Facility | | $49,140.73 | $50,873.03 | $50,873.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,008.22 / $42,284.31 / $76,377.94
| Facility | | $30,008.22 | $42,284.31 | $76,377.94 |
- 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
- $30,008.22 / $42,284.31 / $77,648.53
| Facility | | $30,008.22 | $42,284.31 | $77,648.53 |