- 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
- $11,481.54 / $18,620.87 / $29,512.09
| Facility | | $11,481.54 | $18,620.87 | $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 / $29,512.09
| Facility | | $12,882.50 | $12,882.50 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $19,952.62 / $29,512.09
| Facility | | $13,803.84 | $19,952.62 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $19,054.61 / $20,417.38
| Facility | | $14,791.08 | $19,054.61 | $20,417.38 |