- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66,941.60 / $66,941.60 / $66,941.60
| Facility | | $66,941.60 | $66,941.60 | $66,941.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51,454.73 / $53,268.59 / $53,268.59
| Facility | | $51,454.73 | $53,268.59 | $53,268.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,421.28 / $44,275.44 / $80,346.87
| Facility | | $31,421.28 | $44,275.44 | $80,346.87 |
- 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
- $31,421.28 / $44,275.44 / $81,304.94
| Facility | | $31,421.28 | $44,275.44 | $81,304.94 |