- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48,977.88 / $48,977.88 / $48,977.88
| Facility | | $48,977.88 | $48,977.88 | $48,977.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,902.95 / $42,657.95 / $64,565.42
| Facility | | $30,902.95 | $42,657.95 | $64,565.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,902.95 / $36,307.81 / $58,884.37
| Facility | | $30,902.95 | $36,307.81 | $58,884.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,884.42 / $52,480.75 / $54,954.09
| Facility | | $33,884.42 | $52,480.75 | $54,954.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,840.32 / $33,884.42 / $60,255.96
| Facility | | $28,840.32 | $33,884.42 | $60,255.96 |