- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $6,606.93 / $6,606.93
| Facility | | $6,606.93 | $6,606.93 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $9,772.37 / $16,218.10
| Facility | | $6,165.95 | $9,772.37 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,952.62 / $26,302.68 / $27,542.29
| Facility | | $19,952.62 | $26,302.68 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $6,606.93 / $15,848.93
| Facility | | $6,606.93 | $6,606.93 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $10,715.19 / $16,595.87
| Facility | | $7,585.78 | $10,715.19 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $9,772.37 / $10,715.19
| Facility | | $7,762.47 | $9,772.37 | $10,715.19 |