- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $144.54 / $186.21
| Facility | | $75.86 | $144.54 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $141.25 / $165.96
| Facility | | $109.65 | $141.25 | $165.96 |
- 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
- $70.79 / $162.18 / $229.09
| Facility | | $70.79 | $162.18 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $199.53 / $346.74
| Facility | | $100.00 | $199.53 | $346.74 |