- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.77 / $51.80 / $13,723.62
| Facility | | $36.77 | $51.80 | $13,723.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.77 / $36.77 / $37.13
| Professional | | $36.77 | $36.77 | $37.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.68 / $37.11 / $48.04
| Facility | | $34.68 | $37.11 | $48.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.77 / $36.77 / $36.77
| Professional | | $36.77 | $36.77 | $36.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69.72 / $8,702.00 / $13,785.00
| Facility | | $69.72 | $8,702.00 | $13,785.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.02 / $36.74 / $36.74
| Professional | | $36.02 | $36.74 | $36.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.77 / $36.77 / $46.51
| Professional | | $36.77 | $36.77 | $46.51 |