- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52,402.50 / $52,402.50 / $52,402.50
| Facility | | $52,402.50 | $52,402.50 | $52,402.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40,279.25 / $41,699.17 / $41,699.17
| Facility | | $40,279.25 | $41,699.17 | $41,699.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,596.88 / $34,659.24 / $67,384.66
| Facility | | $24,596.88 | $34,659.24 | $67,384.66 |
- 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
- $24,596.88 / $34,659.24 / $63,646.29
| Facility | | $24,596.88 | $34,659.24 | $63,646.29 |