- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $234.42 / $426.58
| Facility | | $112.20 | $234.42 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.15 / $64.57 / $218.78
| Facility | | $37.15 | $64.57 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $125.89 / $257.04
| Facility | | $60.26 | $125.89 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $64.57 / $162.18
| Facility | | $39.81 | $64.57 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,023.29 / $1,023.29
| Facility | | $1,023.29 | $1,023.29 | $1,023.29 |