- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,914.67 / $8,914.67 / $8,914.67
| Facility | | $8,914.67 | $8,914.67 | $8,914.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,852.27 / $7,093.83 / $7,093.83
| Facility | | $6,852.27 | $7,093.83 | $7,093.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.39 / $5,896.20 / $11,501.39
| Facility | | $4,184.39 | $5,896.20 | $11,501.39 |
- 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
- $4,184.39 / $5,896.20 / $10,827.45
| Facility | | $4,184.39 | $5,896.20 | $10,827.45 |