- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $7,762.47 / $7,762.47
| Facility | | $7,762.47 | $7,762.47 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $9,332.54 / $16,595.87
| Facility | | $6,760.83 | $9,332.54 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,902.95 / $30,902.95 / $32,359.37
| Facility | | $30,902.95 | $30,902.95 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $7,762.47 / $16,982.44
| Facility | | $7,762.47 | $7,762.47 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $11,481.54 / $12,589.25
| Facility | | $9,120.11 | $11,481.54 | $12,589.25 |