- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $12,302.69 / $19,054.61
| Facility | | $7,585.78 | $12,302.69 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,387.21 / $29,512.09 / $30,902.95
| Facility | | $22,387.21 | $29,512.09 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $17,782.79
| Facility | | $7,413.10 | $7,413.10 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $12,302.69 / $18,197.01
| Facility | | $8,317.64 | $12,302.69 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $12,022.64 / $19,054.61
| Facility | | $8,709.64 | $12,022.64 | $19,054.61 |