- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,043.40 / $22,043.40 / $22,043.40
| Facility | | $22,043.40 | $22,043.40 | $22,043.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,943.70 / $17,541.00 / $17,541.00
| Facility | | $16,943.70 | $17,541.00 | $17,541.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,346.82 / $14,579.61 / $26,042.24
| Facility | | $10,346.82 | $14,579.61 | $26,042.24 |
- 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
- $10,346.82 / $14,579.61 / $26,773.18
| Facility | | $10,346.82 | $14,579.61 | $26,773.18 |