- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $9,772.37 / $9,772.37
| Facility | | $9,772.37 | $9,772.37 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $15,848.93 / $24,547.09
| Facility | | $9,772.37 | $15,848.93 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,512.09 / $38,904.51 / $40,738.03
| Facility | | $29,512.09 | $38,904.51 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $9,772.37 / $23,442.29
| Facility | | $9,772.37 | $9,772.37 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $15,848.93 / $23,442.29
| Facility | | $10,471.29 | $15,848.93 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $14,454.40 / $15,488.17
| Facility | | $11,220.18 | $14,454.40 | $15,488.17 |