- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $794.33 / $1,949.84
| Professional | | $575.44 | $794.33 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46,773.51 / $81,283.05 / $95,499.26
| Facility | | $46,773.51 | $81,283.05 | $95,499.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $1,000.00 / $1,096.48
| Professional | | $489.78 | $1,000.00 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,096.48 / $1,258.93
| Facility | | $977.24 | $1,096.48 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,096.48 / $1,258.93
| Professional | | $977.24 | $1,096.48 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $691.83 / $1,000.00
| Facility | | $575.44 | $691.83 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $831.76 / $1,230.27
| Professional | | $79.43 | $831.76 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $977.24 / $1,122.02
| Professional | | $870.96 | $977.24 | $1,122.02 |