- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61,767.20 / $61,767.20 / $61,767.20
| Facility | | $61,767.20 | $61,767.20 | $61,767.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47,477.38 / $49,151.04 / $49,151.04
| Facility | | $47,477.38 | $49,151.04 | $49,151.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,992.48 / $40,853.04 / $72,849.62
| Facility | | $28,992.48 | $40,853.04 | $72,849.62 |
- 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
- $28,992.48 / $40,853.04 / $75,020.24
| Facility | | $28,992.48 | $40,853.04 | $75,020.24 |