- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $5,623.41
| Facility | | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $9,332.54 / $14,791.08
| Facility | | $5,888.44 | $9,332.54 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $21,877.62 / $22,908.68
| Facility | | $16,595.87 | $21,877.62 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $13,803.84
| Facility | | $5,623.41 | $5,623.41 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $9,332.54 / $14,791.08
| Facility | | $6,606.93 | $9,332.54 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $8,128.31 / $8,912.51
| Facility | | $6,456.54 | $8,128.31 | $8,912.51 |