- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,123.90 / $10,123.90 / $10,123.90
| Facility | | $10,123.90 | $10,123.90 | $10,123.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,781.76 / $8,056.08 / $8,056.08
| Facility | | $7,781.76 | $8,056.08 | $8,056.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,752.00 / $6,696.00 / $12,183.45
| Facility | | $4,752.00 | $6,696.00 | $12,183.45 |
- 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
- $4,752.00 / $6,696.00 / $12,296.16
| Facility | | $4,752.00 | $6,696.00 | $12,296.16 |