- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,767.00 / $9,062.00 / $18,276.00
| Facility | | $2,767.00 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,114.82 / $27,416.96 / $43,667.88
| Facility | | $12,114.82 | $27,416.96 | $43,667.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $890.00 / $2,767.50
| Facility | | $890.00 | $890.00 | $2,767.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,655.53 / $3,320.40 / $5,386.81
| Facility | | $2,655.53 | $3,320.40 | $5,386.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $19,915.00 / $30,476.00
| Facility | | $3,340.00 | $19,915.00 | $30,476.00 |