- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $15,135.61 / $27,542.29
| Facility | | $7,079.46 | $15,135.61 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $7,079.46 / $7,079.46
| Facility | | $7,079.46 | $7,079.46 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $11,748.98 / $19,054.61
| Facility | | $5,888.44 | $11,748.98 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $16,982.44 / $23,442.29
| Facility | | $10,471.29 | $16,982.44 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $12,882.50 / $27,542.29
| Facility | | $5,370.32 | $12,882.50 | $27,542.29 |