- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,824.30 / $20,824.30 / $20,824.30
| Facility | | $20,824.30 | $20,824.30 | $20,824.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,006.65 / $16,570.91 / $16,570.91
| Facility | | $16,006.65 | $16,570.91 | $16,570.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,774.60 / $13,773.30 / $25,649.45
| Facility | | $9,774.60 | $13,773.30 | $25,649.45 |
- 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
- $9,774.60 / $13,773.30 / $25,292.52
| Facility | | $9,774.60 | $13,773.30 | $25,292.52 |