- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,084.50 / $10,084.50 / $10,084.50
| Facility | | $10,084.50 | $10,084.50 | $10,084.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,751.50 / $8,024.75 / $8,024.75
| Facility | | $7,751.50 | $8,024.75 | $8,024.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,733.52 / $6,669.96 / $12,538.67
| Facility | | $4,733.52 | $6,669.96 | $12,538.67 |
- 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
- $4,733.52 / $6,669.96 / $12,248.34
| Facility | | $4,733.52 | $6,669.96 | $12,248.34 |