- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $30,774.80 / $50,260.50
| Facility | | $6,303.00 | $30,774.80 | $50,260.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40,646.44 / $55,902.81 / $75,009.50
| Facility | | $40,646.44 | $55,902.81 | $75,009.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,302.64 / $45,733.37 / $64,110.68
| Facility | | $33,302.64 | $45,733.37 | $64,110.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,992.96 / $50,792.04 / $64,032.16
| Facility | | $28,992.96 | $50,792.04 | $64,032.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,992.96 / $51,214.86 / $67,157.96
| Facility | | $28,992.96 | $51,214.86 | $67,157.96 |