- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.00 / $13,800.00 / $40,224.00
| Facility | | $950.00 | $13,800.00 | $40,224.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,697.87 / $20,697.87 / $20,697.87
| Facility | | $20,697.87 | $20,697.87 | $20,697.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $22,419.60 / $34,151.17
| Facility | | $2,200.00 | $22,419.60 | $34,151.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,714.18 / $28,219.81 / $38,159.43
| Facility | | $18,714.18 | $28,219.81 | $38,159.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,020.05 / $35,013.39 / $49,256.39
| Facility | | $20,020.05 | $35,013.39 | $49,256.39 |