- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,538.45 / $14,874.10 / $18,952.80
| Facility | | $9,538.45 | $14,874.10 | $18,952.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,949.37 / $21,949.37 / $21,949.37
| Facility | | $21,949.37 | $21,949.37 | $21,949.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,704.82 / $15,236.58 / $17,946.72
| Facility | | $7,704.82 | $15,236.58 | $17,946.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,118.62 / $15,452.31 / $21,647.55
| Facility | | $8,118.62 | $15,452.31 | $21,647.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,683.68 / $16,856.32 / $21,647.55
| Facility | | $14,683.68 | $16,856.32 | $21,647.55 |