- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $794.33 / $1,202.26
| Facility | | $109.65 | $794.33 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $125.89 / $151.36
| Facility | | $125.89 | $125.89 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $199.53 / $199.53
| Facility | | $34.67 | $199.53 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $1,949.84 / $1,949.84
| Facility | | $1,949.84 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $691.83 / $2,187.76
| Facility | | $691.83 | $691.83 | $2,187.76 |