- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $120.23 / $173.78
| Facility | | $120.23 | $120.23 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $102.33 / $208.93
| Facility | | $83.18 | $102.33 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,137.96 / $4,073.80
| Facility | | $1,905.46 | $2,137.96 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $954.99 / $2,089.30
| Facility | | $954.99 | $954.99 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $199.53 / $346.74
| Facility | | $100.00 | $199.53 | $346.74 |