- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,420.40 / $23,761.80 / $48,277.50
| Facility | | $12,420.40 | $23,761.80 | $48,277.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36,321.04 / $36,321.04 / $38,590.43
| Facility | | $36,321.04 | $36,321.04 | $38,590.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,500.00 / $14,036.98 / $24,603.14
| Facility | | $7,500.00 | $14,036.98 | $24,603.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,500.00 / $15,595.10 / $38,590.43
| Facility | | $7,500.00 | $15,595.10 | $38,590.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,566.00 / $11,566.00 / $11,566.00
| Facility | | $11,566.00 | $11,566.00 | $11,566.00 |