- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,525.00 / $17,426.00 / $28,086.40
| Facility | | $2,525.00 | $17,426.00 | $28,086.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,665.22 / $20,218.23 / $27,709.87
| Facility | | $4,665.22 | $20,218.23 | $27,709.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,854.00 / $15,439.57 / $27,371.70
| Facility | | $1,854.00 | $15,439.57 | $27,371.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,328.00 / $12,480.96 / $26,567.68
| Facility | | $2,328.00 | $12,480.96 | $26,567.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,104.11 / $4,811.39 / $15,778.85
| Facility | | $2,104.11 | $4,811.39 | $15,778.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,850.00 / $12,515.63 / $31,054.41
| Facility | | $1,850.00 | $12,515.63 | $31,054.41 |