- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $12,882.50 / $12,882.50
| Facility | | $10,000.00 | $12,882.50 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,199.52 / $39,810.72 / $60,255.96
| Facility | | $30,199.52 | $39,810.72 | $60,255.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $22,908.68 / $23,988.33
| Facility | | $16,595.87 | $22,908.68 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,417.38 / $20,417.38 / $33,884.42
| Facility | | $20,417.38 | $20,417.38 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $39,810.72 / $70,794.58
| Facility | | $12,882.50 | $39,810.72 | $70,794.58 |