- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $7,079.46 / $7,079.46
| Facility | | $7,079.46 | $7,079.46 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $9,549.93 / $16,595.87
| Facility | | $5,754.40 | $9,549.93 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $28,183.83 / $29,512.09
| Facility | | $21,379.62 | $28,183.83 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $7,079.46 / $16,218.10
| Facility | | $7,079.46 | $7,079.46 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $11,481.54 / $16,982.44
| Facility | | $7,762.47 | $11,481.54 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $10,471.29 / $11,220.18
| Facility | | $8,128.31 | $10,471.29 | $11,220.18 |