- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.00 / $190.00 / $427.00
| Facility | | $102.00 | $190.00 | $427.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.40 / $50.73 / $181.24
| Facility | | $35.40 | $50.73 | $181.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.00 / $174.00 / $260.00
| Facility | | $60.00 | $174.00 | $260.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $76.95 / $161.24
| Facility | | $40.00 | $76.95 | $161.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.00 / $1,650.00 / $1,650.00
| Facility | | $1,650.00 | $1,650.00 | $1,650.00 |