- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54,425.90 / $54,425.90 / $54,425.90
| Facility | | $54,425.90 | $54,425.90 | $54,425.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41,834.53 / $43,309.26 / $43,309.26
| Facility | | $41,834.53 | $43,309.26 | $43,309.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,546.62 / $35,997.51 / $66,411.22
| Facility | | $25,546.62 | $35,997.51 | $66,411.22 |
- 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
- $25,546.62 / $35,997.51 / $66,103.81
| Facility | | $25,546.62 | $35,997.51 | $66,103.81 |