- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,052.40 / $20,052.40 / $20,052.40
| Facility | | $20,052.40 | $20,052.40 | $20,052.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,413.29 / $15,956.63 / $15,956.63
| Facility | | $15,413.29 | $15,956.63 | $15,956.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,412.26 / $13,262.73 / $23,458.34
| Facility | | $9,412.26 | $13,262.73 | $23,458.34 |
- 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
- $9,412.26 / $13,262.73 / $24,354.94
| Facility | | $9,412.26 | $13,262.73 | $24,354.94 |