- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.39 / $1,400.39 / $1,400.39
| Facility | | $1,400.39 | $1,400.39 | $1,400.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.02 / $512.77 / $645.52
| Professional | | $458.02 | $512.77 | $645.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,093.00 / $1,093.00 / $1,093.00
| Professional | | $1,093.00 | $1,093.00 | $1,093.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.90 / $775.11 / $1,342.67
| Professional | | $469.90 | $775.11 | $1,342.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $568.16 / $732.94 / $1,147.43
| Professional | | $568.16 | $732.94 | $1,147.43 |