- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,000.00 / $25,031.40 / $33,577.40
| Facility | | $3,000.00 | $25,031.40 | $33,577.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,044.61 / $27,044.61 / $27,044.61
| Facility | | $27,044.61 | $27,044.61 | $27,044.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,897.00 / $31,081.26 / $36,957.07
| Facility | | $3,897.00 | $31,081.26 | $36,957.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,276.66 / $25,847.60 / $40,683.33
| Facility | | $21,276.66 | $25,847.60 | $40,683.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $31,950.35 / $43,823.00
| Facility | | $1,350.00 | $31,950.35 | $43,823.00 |