- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,001.20 / $27,440.80 / $44,183.20
| Facility | | $12,001.20 | $27,440.80 | $44,183.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,064.34 / $23,064.34 / $23,064.34
| Facility | | $23,064.34 | $23,064.34 | $23,064.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,474.01 / $16,715.83 / $38,264.82
| Facility | | $1,474.01 | $16,715.83 | $38,264.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,214.00 / $23,372.71 / $32,095.27
| Facility | | $12,214.00 | $23,372.71 | $32,095.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,302.03 / $23,477.66 / $50,537.44
| Facility | | $16,302.03 | $23,477.66 | $50,537.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,302.03 / $24,064.04 / $51,189.98
| Facility | | $16,302.03 | $24,064.04 | $51,189.98 |