- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $5,031.20
| Facility | | $0.02 | $0.02 | $5,031.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,000.00 / $32,350.60
| Professional | | $2,000.00 | $2,000.00 | $32,350.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,635.14 / $5,031.20 / $12,074.88
| Facility | | $1,635.14 | $5,031.20 | $12,074.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $846.27 / $846.27 / $3,043.87
| Professional | | $846.27 | $846.27 | $3,043.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,270.28 / $5,886.50 / $18,215.46
| Facility | | $3,270.28 | $5,886.50 | $18,215.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,557.31 / $6,128.48 / $7,342.62
| Professional | | $2,557.31 | $6,128.48 | $7,342.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,132.02 / $1,257.80 / $5,031.20
| Professional | | $1,132.02 | $1,257.80 | $5,031.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,257.80 / $1,257.80 / $1,257.80
| Professional | | $1,257.80 | $1,257.80 | $1,257.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,546.80 / $7,546.80 / $7,546.80
| Facility | | $7,546.80 | $7,546.80 | $7,546.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,113.10 / $2,113.10 / $5,031.20
| Professional | | $2,113.10 | $2,113.10 | $5,031.20 |