- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,294.60 / $12,549.60 / $12,549.60
| Facility | | $11,294.60 | $12,549.60 | $12,549.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,650.01 / $10,416.78 / $14,141.00
| Facility | | $5,650.01 | $10,416.78 | $14,141.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,086.06 / $8,905.96 / $15,802.34
| Facility | | $5,086.06 | $8,905.96 | $15,802.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,832.16 / $13,817.52 / $21,715.20
| Facility | | $7,832.16 | $13,817.52 | $21,715.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $15,917.04 / $24,207.84
| Facility | | $6,965.00 | $15,917.04 | $24,207.84 |