- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,481.70 / $13,481.70 / $13,481.70
| Facility | | $13,481.70 | $13,481.70 | $13,481.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,396.24 / $10,728.01 / $10,728.01
| Facility | | $9,396.24 | $10,728.01 | $10,728.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,300.00 / $7,095.12 / $15,450.47
| Facility | | $4,300.00 | $7,095.12 | $15,450.47 |
- 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
- $4,300.00 / $7,924.00 / $15,594.88
| Facility | | $4,300.00 | $7,924.00 | $15,594.88 |