- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $1,202.26 / $3,467.37
| Facility | | $102.33 | $1,202.26 | $3,467.37 |
- 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
- $177.83 / $177.83 / $177.83
| Facility | | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $4,786.30
| Facility | | $1,148.15 | $1,148.15 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $3,311.31
| Facility | | $1,230.27 | $1,230.27 | $3,311.31 |