- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54,344.40 / $54,344.40 / $54,344.40
| Facility | | $54,344.40 | $54,344.40 | $54,344.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41,771.83 / $43,244.37 / $43,244.37
| Facility | | $41,771.83 | $43,244.37 | $43,244.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,508.34 / $35,943.57 / $67,109.71
| Facility | | $25,508.34 | $35,943.57 | $67,109.71 |
- 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
- $25,508.34 / $35,943.57 / $66,004.75
| Facility | | $25,508.34 | $35,943.57 | $66,004.75 |