- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $86,171.40 / $86,171.40 / $86,171.40
| Facility | | $86,171.40 | $86,171.40 | $86,171.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66,235.75 / $68,570.67 / $68,570.67
| Facility | | $66,235.75 | $68,570.67 | $68,570.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40,447.44 / $56,994.12 / $102,310.88
| Facility | | $40,447.44 | $56,994.12 | $102,310.88 |
- 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
- $40,447.44 / $56,994.12 / $104,660.82
| Facility | | $40,447.44 | $56,994.12 | $104,660.82 |