- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $131.83 / $165.96
| Facility | | $85.11 | $131.83 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $309.03 / $309.03
| Facility | | $141.25 | $309.03 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $154.88 / $194.98
| Facility | | $120.23 | $154.88 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $186.21 / $239.88
| Facility | | $125.89 | $186.21 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $75.86
| Facility | | $50.12 | $50.12 | $75.86 |