- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,125.10 / $27,125.10 / $27,125.10
| Facility | | $27,125.10 | $27,125.10 | $27,125.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,849.71 / $21,584.70 / $21,584.70
| Facility | | $20,849.71 | $21,584.70 | $21,584.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,732.06 / $17,940.63 / $33,901.54
| Facility | | $12,732.06 | $17,940.63 | $33,901.54 |
- 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
- $12,732.06 / $17,940.63 / $32,945.17
| Facility | | $12,732.06 | $17,940.63 | $32,945.17 |