- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,558.80 / $14,558.80 / $14,558.80
| Facility | | $14,558.80 | $14,558.80 | $14,558.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,190.60 / $11,585.09 / $11,585.09
| Facility | | $11,190.60 | $11,585.09 | $11,585.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,833.64 / $9,629.21 / $17,532.27
| Facility | | $6,833.64 | $9,629.21 | $17,532.27 |
- 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
- $6,833.64 / $9,629.21 / $17,682.56
| Facility | | $6,833.64 | $9,629.21 | $17,682.56 |