- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.52 / $398.58 / $443.63
| Professional | | $367.52 | $398.58 | $443.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,753.00 / $8,753.00 / $8,753.00
| Professional | | $8,753.00 | $8,753.00 | $8,753.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,839.18 / $19,839.18 / $19,839.18
| Facility | | $19,839.18 | $19,839.18 | $19,839.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.33 / $489.45 / $878.02
| Professional | | $384.33 | $489.45 | $878.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.54 / $459.76 / $774.28
| Professional | | $354.54 | $459.76 | $774.28 |