- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,022.30 / $22,022.30 / $22,022.30
| Facility | | $22,022.30 | $22,022.30 | $22,022.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,927.49 / $17,524.21 / $17,524.21
| Facility | | $16,927.49 | $17,524.21 | $17,524.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,336.92 / $14,565.66 / $26,986.66
| Facility | | $10,336.92 | $14,565.66 | $26,986.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,450.00 / $1,450.00 / $1,450.00
| Facility | | $1,450.00 | $1,450.00 | $1,450.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,453.62 / $16,374.62 / $26,800.81
| Facility | | $11,453.62 | $16,374.62 | $26,800.81 |