- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,049.10 / $11,049.10 / $11,049.10
| Facility | | $11,049.10 | $11,049.10 | $11,049.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,492.93 / $8,792.32 / $8,792.32
| Facility | | $8,492.93 | $8,792.32 | $8,792.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,186.28 / $7,307.94 / $11,584.01
| Facility | | $5,186.28 | $7,307.94 | $11,584.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.00 / $950.00 / $950.00
| Facility | | $950.00 | $950.00 | $950.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,186.28 / $7,307.94 / $13,419.89
| Facility | | $5,186.28 | $7,307.94 | $13,419.89 |