- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53,984.40 / $53,984.40 / $53,984.40
| Facility | | $53,984.40 | $53,984.40 | $53,984.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41,495.15 / $42,957.93 / $42,957.93
| Facility | | $41,495.15 | $42,957.93 | $42,957.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,339.38 / $35,705.49 / $68,033.63
| Facility | | $25,339.38 | $35,705.49 | $68,033.63 |
- 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
- $25,339.38 / $35,705.49 / $65,567.57
| Facility | | $25,339.38 | $35,705.49 | $65,567.57 |