- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,287.40 / $36,272.40 / $60,707.20
| Facility | | $26,287.40 | $36,272.40 | $60,707.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47,126.25 / $47,126.25 / $47,126.25
| Facility | | $47,126.25 | $47,126.25 | $47,126.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,494.00 / $42,572.52 / $65,952.87
| Facility | | $3,494.00 | $42,572.52 | $65,952.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,904.92 / $41,657.00 / $68,434.81
| Facility | | $26,904.92 | $41,657.00 | $68,434.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.00 / $41,613.33 / $73,233.30
| Facility | | $4,062.00 | $41,613.33 | $73,233.30 |