- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,004.00 / $12,676.80 / $16,000.40
| Facility | | $7,004.00 | $12,676.80 | $16,000.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,356.00 / $11,475.12 / $11,673.91
| Facility | | $5,356.00 | $11,475.12 | $11,673.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.00 / $150.00 / $150.00
| Facility | | $150.00 | $150.00 | $150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,700.00 / $12,699.13 / $20,769.13
| Facility | | $5,700.00 | $12,699.13 | $20,769.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,700.00 / $13,237.43 / $20,769.13
| Facility | | $5,700.00 | $13,237.43 | $20,769.13 |