- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56,020.40 / $56,020.40 / $56,020.40
| Facility | | $56,020.40 | $56,020.40 | $56,020.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,060.15 / $44,578.09 / $44,578.09
| Facility | | $43,060.15 | $44,578.09 | $44,578.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,295.06 / $37,052.12 / $61,221.21
| Facility | | $26,295.06 | $37,052.12 | $61,221.21 |
- 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
- $26,295.06 / $37,052.12 / $68,040.46
| Facility | | $26,295.06 | $37,052.12 | $68,040.46 |