- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,505.60 / $13,505.60 / $13,505.60
| Facility | | $13,505.60 | $13,505.60 | $13,505.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,381.08 / $10,747.03 / $10,747.03
| Facility | | $10,381.08 | $10,747.03 | $10,747.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,339.30 / $8,932.65 / $16,309.49
| Facility | | $6,339.30 | $8,932.65 | $16,309.49 |
- 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
- $6,339.30 / $8,932.65 / $16,403.41
| Facility | | $6,339.30 | $8,932.65 | $16,403.41 |