- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.00 / $230.00 / $230.00
| Facility | | $200.00 | $230.00 | $230.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.32 / $216.43 / $1,182.05
| Facility | | $37.32 | $216.43 | $1,182.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.00 / $110.00 / $186.00
| Facility | | $65.00 | $110.00 | $186.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.00 / $140.00 / $145.00
| Facility | | $140.00 | $140.00 | $145.00 |