- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,506.09 / $35,404.40 / $71,932.30
| Facility | | $18,506.09 | $35,404.40 | $71,932.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54,117.42 / $54,117.42 / $57,498.75
| Facility | | $54,117.42 | $54,117.42 | $57,498.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,500.00 / $20,914.75 / $32,703.61
| Facility | | $7,500.00 | $20,914.75 | $32,703.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,500.00 / $20,729.70 / $57,498.75
| Facility | | $7,500.00 | $20,729.70 | $57,498.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,391.00 / $17,391.00 / $17,391.00
| Facility | | $17,391.00 | $17,391.00 | $17,391.00 |