- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,462.90 / $15,462.90 / $15,462.90
| Facility | | $15,462.90 | $15,462.90 | $15,462.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,885.56 / $12,304.54 / $12,304.54
| Facility | | $11,885.56 | $12,304.54 | $12,304.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,258.02 / $10,227.20 / $18,266.63
| Facility | | $7,258.02 | $10,227.20 | $18,266.63 |
- 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
- $7,258.02 / $10,227.20 / $18,780.68
| Facility | | $7,258.02 | $10,227.20 | $18,780.68 |