- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107,965.00 / $107,965.00 / $107,965.00
| Facility | | $107,965.00 | $107,965.00 | $107,965.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82,987.07 / $85,912.50 / $85,912.50
| Facility | | $82,987.07 | $85,912.50 | $85,912.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50,676.78 / $71,408.19 / $132,141.03
| Facility | | $50,676.78 | $71,408.19 | $132,141.03 |
- 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
- $50,676.78 / $71,408.19 / $131,130.01
| Facility | | $50,676.78 | $71,408.19 | $131,130.01 |