- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63,000.30 / $63,000.30 / $63,000.30
| Facility | | $63,000.30 | $63,000.30 | $63,000.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48,425.24 / $50,132.31 / $50,132.31
| Facility | | $48,425.24 | $50,132.31 | $50,132.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,571.30 / $41,668.65 / $71,567.07
| Facility | | $29,571.30 | $41,668.65 | $71,567.07 |
- 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
- $29,571.30 / $41,668.65 / $76,517.98
| Facility | | $29,571.30 | $41,668.65 | $76,517.98 |