- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $251.19 / $1,412.54
| Facility | | $102.33 | $251.19 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $109.65 / $131.83
| Facility | | $109.65 | $109.65 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $173.78 / $173.78
| Facility | | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $4,073.80 / $4,073.80
| Facility | | $4,073.80 | $4,073.80 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $5,370.32
| Facility | | $1,230.27 | $1,230.27 | $5,370.32 |