- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $8,128.31 / $8,128.31
| Facility | | $8,128.31 | $8,128.31 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $12,589.25 / $19,952.62
| Facility | | $7,585.78 | $12,589.25 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,547.09 / $32,359.37 / $33,884.42
| Facility | | $24,547.09 | $32,359.37 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $8,128.31 / $19,054.61
| Facility | | $8,128.31 | $8,128.31 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $12,589.25 / $19,054.61
| Facility | | $8,912.51 | $12,589.25 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $12,022.64 / $12,882.50
| Facility | | $9,332.54 | $12,022.64 | $12,882.50 |