- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,067.60 / $21,067.60 / $21,067.60
| Facility | | $21,067.60 | $21,067.60 | $21,067.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,193.63 / $16,764.48 / $16,764.48
| Facility | | $16,193.63 | $16,764.48 | $16,764.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,888.78 / $13,934.19 / $25,205.42
| Facility | | $9,888.78 | $13,934.19 | $25,205.42 |
- 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
- $10,957.07 / $15,664.73 / $25,638.91
| Facility | | $10,957.07 | $15,664.73 | $25,638.91 |