- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,491.60 / $13,879.50 / $13,879.50
| Facility | | $12,491.60 | $13,879.50 | $13,879.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,634.78 / $10,634.78 / $12,431.48
| Facility | | $10,634.78 | $10,634.78 | $12,431.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,610.88 / $10,933.26 / $20,750.46
| Facility | | $6,610.88 | $10,933.26 | $20,750.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,473.09 / $15,668.80 / $24,016.41
| Facility | | $11,473.09 | $15,668.80 | $24,016.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $17,603.80 / $26,773.20
| Facility | | $6,965.00 | $17,603.80 | $26,773.20 |