- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,895.00 / $12,833.00 / $28,936.50
| Facility | | $3,895.00 | $12,833.00 | $28,936.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,201.00 / $18,186.78 / $30,175.00
| Facility | | $2,201.00 | $18,186.78 | $30,175.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,635.00 / $5,457.00 / $27,633.28
| Facility | | $1,635.00 | $5,457.00 | $27,633.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,565.00 / $22,918.00 / $31,407.00
| Facility | | $4,565.00 | $22,918.00 | $31,407.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,613.00 / $7,245.00 / $37,861.26
| Facility | | $1,613.00 | $7,245.00 | $37,861.26 |