- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58,898.70 / $58,898.70 / $58,898.70
| Facility | | $58,898.70 | $58,898.70 | $58,898.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45,272.55 / $46,868.48 / $46,868.48
| Facility | | $45,272.55 | $46,868.48 | $46,868.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,646.08 / $38,955.83 / $70,226.44
| Facility | | $27,646.08 | $38,955.83 | $70,226.44 |
- 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
- $27,646.08 / $38,955.83 / $71,536.33
| Facility | | $27,646.08 | $38,955.83 | $71,536.33 |