- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.33 / $125.89 / $323.59
| Facility | | $93.33 | $125.89 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $870.96 / $2,137.96
| Facility | | $363.08 | $870.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $467.74 / $1,122.02
| Facility | | $331.13 | $467.74 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $112.20 / $112.20 / $112.20
| Facility | 54 | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $446.68 / $891.25
| Facility | | $363.08 | $446.68 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.33 / $190.55 / $575.44
| Facility | | $93.33 | $190.55 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,819.70 / $3,467.37
| Facility | | $602.56 | $1,819.70 | $3,467.37 |