- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,994.40 / $15,994.40 / $15,994.40
| Facility | | $15,994.40 | $15,994.40 | $15,994.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,294.10 / $12,727.49 / $12,727.49
| Facility | | $12,294.10 | $12,727.49 | $12,727.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,507.50 / $10,578.75 / $17,501.53
| Facility | | $7,507.50 | $10,578.75 | $17,501.53 |
- 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
- $7,507.50 / $10,578.75 / $19,426.23
| Facility | | $7,507.50 | $10,578.75 | $19,426.23 |