- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $12,882.50 / $12,882.50
| Facility | | $12,882.50 | $12,882.50 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $17,378.01 / $29,512.09
| Facility | | $10,471.29 | $17,378.01 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,904.51 / $51,286.14 / $53,703.18
| Facility | | $38,904.51 | $51,286.14 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $12,882.50 / $26,302.68
| Facility | | $12,882.50 | $12,882.50 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $20,417.38 / $30,199.52
| Facility | | $12,882.50 | $20,417.38 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $19,054.61 / $20,892.96
| Facility | | $15,135.61 | $19,054.61 | $20,892.96 |