- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.00 / $1,403.00 / $1,546.00
| Facility | | $650.00 | $1,403.00 | $1,546.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $249.91 / $628.03 / $2,196.60
| Facility | | $249.91 | $628.03 | $2,196.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.00 / $549.00 / $1,030.00
| Facility | | $352.00 | $549.00 | $1,030.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $402.00 / $872.00 / $1,378.00
| Facility | | $402.00 | $872.00 | $1,378.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $721.42 / $1,456.92 / $2,827.49
| Facility | | $721.42 | $1,456.92 | $2,827.49 |