- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,344.23 / $8,128.31
| Facility | | $630.96 | $2,344.23 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $1,000.00 / $8,511.38
| Professional | | $467.74 | $1,000.00 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $870.96 / $7,244.36
| Professional | | $630.96 | $870.96 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $6,760.83 / $9,120.11
| Facility | | $6,760.83 | $6,760.83 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $707.95 / $7,762.47
| Professional | | $537.03 | $707.95 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $912.01 / $10,715.19
| Professional | | $562.34 | $912.01 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $8,317.64
| Professional | | $1,000.00 | $1,000.00 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $5,888.44 / $14,454.40
| Facility | | $2,187.76 | $5,888.44 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $5,623.41 / $10,715.19
| Professional | | $489.78 | $5,623.41 | $10,715.19 |