- 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
- $1,905.46 / $3,090.30 / $5,248.07
| Facility | | $1,905.46 | $3,090.30 | $5,248.07 |
- 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 / $29,512.09 / $30,199.52
| Facility | | $12,882.50 | $29,512.09 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,548.13 / $4,365.16
| Facility | | $2,454.71 | $3,548.13 | $4,365.16 |
- 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 |