- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,645.90 / $14,645.90 / $14,645.90
| Facility | | $14,645.90 | $14,645.90 | $14,645.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,257.61 / $11,654.46 / $11,654.46
| Facility | | $11,257.61 | $11,654.46 | $11,654.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,874.56 / $9,686.87 / $16,336.81
| Facility | | $6,874.56 | $9,686.87 | $16,336.81 |
- 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
- $6,874.56 / $9,686.87 / $17,788.43
| Facility | | $6,874.56 | $9,686.87 | $17,788.43 |