- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,000.00 / $20,079.00 / $26,934.20
| Facility | | $3,000.00 | $20,079.00 | $26,934.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,790.00 / $27,790.00 / $27,790.00
| Facility | | $27,790.00 | $27,790.00 | $27,790.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,897.00 / $27,602.05 / $32,820.12
| Facility | | $3,897.00 | $27,602.05 | $32,820.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,067.15 / $20,733.75 / $35,955.25
| Facility | | $17,067.15 | $20,733.75 | $35,955.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $25,629.10 / $36,753.30
| Facility | | $1,350.00 | $25,629.10 | $36,753.30 |