- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.28 / $81.05 / $90.56
| Facility | | $45.28 | $81.05 | $90.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.14 / $28,874.72 / $41,999.58
| Facility | | $56.14 | $28,874.72 | $41,999.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.14 / $34,124.66 / $36,749.62
| Professional | | $56.14 | $34,124.66 | $36,749.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.28 / $47.49 / $58.58
| Professional | | $45.28 | $47.49 | $58.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.45 / $45.45 / $56.67
| Professional | | $45.45 | $45.45 | $56.67 |