- 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
- $104.91 / $166.01 / $196.93
| Facility | | $104.91 | $166.01 | $196.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.21 / $216.37 / $1,182.05
| Facility | | $37.21 | $216.37 | $1,182.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.00 / $110.00 / $172.00
| Facility | | $65.00 | $110.00 | $172.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |