- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $120.23 / $128.82
| Facility | | $120.23 | $120.23 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.88 / $83.18 / $128.82
| Facility | | $58.88 | $83.18 | $128.82 |
- 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 |