- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.03 / $15,948.90 / $15,948.90
| Facility | | $0.03 | $15,948.90 | $15,948.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $2,000.00 / $9,056.16
| Professional | | $0.02 | $2,000.00 | $9,056.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,404.81 / $5,131.82 / $6,451.71
| Facility | | $1,404.81 | $5,131.82 | $6,451.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $677.02 / $846.27 / $4,528.08
| Professional | | $677.02 | $846.27 | $4,528.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,031.20 / $7,295.24 / $10,813.53
| Facility | | $5,031.20 | $7,295.24 | $10,813.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,016.08 / $8,865.03 / $15,513.82
| Facility | | $5,016.08 | $8,865.03 | $15,513.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,294.16 / $7,682.42 / $28,318.38
| Professional | | $2,294.16 | $7,682.42 | $28,318.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,528.08 / $6,540.56 / $39,215.33
| Professional | | $4,528.08 | $6,540.56 | $39,215.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,087.75 / $7,043.68 / $9,307.71
| Professional | | $6,087.75 | $7,043.68 | $9,307.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,113.10 / $3,018.72 / $10,361.25
| Professional | | $2,113.10 | $3,018.72 | $10,361.25 |