- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.77 / $0.77 / $0.77
| Facility | | $0.77 | $0.77 | $0.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,452.57 / $2,291.14 / $3,646.03
| Facility | | $1,452.57 | $2,291.14 | $3,646.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.53 / $154.53 / $2,339.27
| Facility | | $153.53 | $154.53 | $2,339.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.78 / $403.66 / $2,237.00
| Facility | | $0.78 | $403.66 | $2,237.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.00 / $1,279.00 / $2,637.00
| Facility | | $352.00 | $1,279.00 | $2,637.00 |