- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,260.29 / $10,260.29 / $10,260.29
| Facility | | $10,260.29 | $10,260.29 | $10,260.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,886.60 / $8,164.61 / $8,164.61
| Facility | | $7,886.60 | $8,164.61 | $8,164.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,816.02 / $6,786.21 / $12,289.33
| Facility | | $4,816.02 | $6,786.21 | $12,289.33 |
- 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
- $4,816.02 / $6,786.21 / $12,461.82
| Facility | | $4,816.02 | $6,786.21 | $12,461.82 |