- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,866.90 / $38,007.80 / $77,221.60
| Facility | | $19,866.90 | $38,007.80 | $77,221.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58,096.76 / $58,096.76 / $61,726.73
| Facility | | $58,096.76 | $58,096.76 | $61,726.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,500.00 / $22,452.65 / $33,616.19
| Facility | | $7,500.00 | $22,452.65 | $33,616.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,500.00 / $21,308.17 / $61,726.73
| Facility | | $7,500.00 | $21,308.17 | $61,726.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,670.00 / $18,670.00 / $18,670.00
| Facility | | $18,670.00 | $18,670.00 | $18,670.00 |