- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.78 / $1,115.53 / $2,461.44
| Facility | | $150.78 | $1,115.53 | $2,461.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.66 / $180.83 / $197.02
| Facility | | $158.66 | $180.83 | $197.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $254.42 / $254.42 / $254.42
| Facility | | $254.42 | $254.42 | $254.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,240.34 / $2,240.34 / $2,240.34
| Facility | | $2,240.34 | $2,240.34 | $2,240.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,225.00 / $1,225.00 / $1,225.00
| Facility | | $1,225.00 | $1,225.00 | $1,225.00 |