- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $8,912.51 / $8,912.51
| Facility | | $8,912.51 | $8,912.51 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $12,589.25 / $21,379.62
| Facility | | $7,762.47 | $12,589.25 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,915.35 / $35,481.34 / $37,153.52
| Facility | | $26,915.35 | $35,481.34 | $37,153.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $8,912.51 / $20,417.38
| Facility | | $8,912.51 | $8,912.51 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $14,791.08 / $21,877.62
| Facility | | $9,772.37 | $14,791.08 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $13,182.57 / $14,454.40
| Facility | | $10,471.29 | $13,182.57 | $14,454.40 |