- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $371.54 / $1,412.54
| Facility | | $128.82 | $371.54 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $138.04 / $169.82
| Facility | | $138.04 | $138.04 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $218.78
| Facility | | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $9,772.37 / $9,772.37
| Facility | | $9,772.37 | $9,772.37 | $9,772.37 |
- 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 |