- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $7,585.78 / $7,585.78
| Facility | | $7,585.78 | $7,585.78 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $10,232.93 / $18,197.01
| Facility | | $6,165.95 | $10,232.93 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,908.68 / $30,199.52 / $31,622.78
| Facility | | $22,908.68 | $30,199.52 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $7,585.78 / $17,378.01
| Facility | | $7,585.78 | $7,585.78 | $17,378.01 |
- 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
- $8,912.51 / $11,220.18 / $12,302.69
| Facility | | $8,912.51 | $11,220.18 | $12,302.69 |