- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77,193.50 / $77,193.50 / $77,193.50
| Facility | | $77,193.50 | $77,193.50 | $77,193.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59,334.84 / $61,426.49 / $61,426.49
| Facility | | $59,334.84 | $61,426.49 | $61,426.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36,233.33 / $51,056.07 / $94,395.23
| Facility | | $36,233.33 | $51,056.07 | $94,395.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.00 / $950.00 / $950.00
| Facility | | $950.00 | $950.00 | $950.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36,233.33 / $51,056.07 / $93,756.51
| Facility | | $36,233.33 | $51,056.07 | $93,756.51 |