- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,573.10 / $13,573.10 / $13,573.10
| Facility | | $13,573.10 | $13,573.10 | $13,573.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,432.95 / $10,800.74 / $10,800.74
| Facility | | $10,432.95 | $10,800.74 | $10,800.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,370.98 / $8,977.29 / $16,500.75
| Facility | | $6,370.98 | $8,977.29 | $16,500.75 |
- 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
- $6,370.98 / $8,977.29 / $16,485.39
| Facility | | $6,370.98 | $8,977.29 | $16,485.39 |