- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.00 / $350.00 / $507.50
| Facility | | $200.00 | $350.00 | $507.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $335.00 / $400.00 / $458.00
| Facility | | $335.00 | $400.00 | $458.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.00 / $375.00 / $450.00
| Facility | | $350.00 | $375.00 | $450.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,417.40 / $2,417.40 / $2,417.40
| Facility | | $2,417.40 | $2,417.40 | $2,417.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.00 / $450.00 / $583.29
| Facility | | $350.00 | $450.00 | $583.29 |