- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $8,128.31 / $8,128.31
| Facility | | $8,128.31 | $8,128.31 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $17,782.79 / $28,183.83
| Facility | | $10,471.29 | $17,782.79 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,547.09 / $32,359.37 / $33,884.42
| Facility | | $24,547.09 | $32,359.37 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $8,128.31 / $21,379.62
| Facility | | $8,128.31 | $8,128.31 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $13,803.84 / $22,908.68
| Facility | | $9,772.37 | $13,803.84 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $13,182.57 / $79,432.82
| Facility | | $9,549.93 | $13,182.57 | $79,432.82 |