- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $7,943.28 / $7,943.28
| Facility | | $7,943.28 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $10,232.93 / $18,197.01
| Facility | | $5,888.44 | $10,232.93 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,988.33 / $31,622.78 / $33,113.11
| Facility | | $23,988.33 | $31,622.78 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $7,943.28 / $15,848.93
| Facility | | $7,943.28 | $7,943.28 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $12,882.50 / $19,054.61
| Facility | | $8,709.64 | $12,882.50 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $11,748.98 / $12,589.25
| Facility | | $9,120.11 | $11,748.98 | $12,589.25 |