- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,971.09 / $18,971.09 / $18,971.09
| Facility | | $18,971.09 | $18,971.09 | $18,971.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,582.15 / $15,096.20 / $15,096.20
| Facility | | $14,582.15 | $15,096.20 | $15,096.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,904.71 / $12,547.56 / $24,475.84
| Facility | | $8,904.71 | $12,547.56 | $24,475.84 |
- 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
- $8,904.71 / $12,547.56 / $23,041.64
| Facility | | $8,904.71 | $12,547.56 | $23,041.64 |