- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,019.66 / $14,065.10 / $17,922.00
| Facility | | $9,019.66 | $14,065.10 | $17,922.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,190.16 / $14,190.16 / $14,190.16
| Facility | | $14,190.16 | $14,190.16 | $14,190.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,490.32 / $14,407.85 / $16,970.58
| Facility | | $7,490.32 | $14,407.85 | $16,970.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,677.04 / $14,611.84 / $20,470.12
| Facility | | $7,677.04 | $14,611.84 | $20,470.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,885.02 / $15,939.49 / $20,470.12
| Facility | | $13,885.02 | $15,939.49 | $20,470.12 |