- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.05 / $20,778.90
| Facility | | $0.02 | $0.05 | $20,778.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,289.00 / $32,350.60 / $32,350.60
| Professional | | $6,289.00 | $32,350.60 | $32,350.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $8,639.91 / $79,506.39
| Facility | | $5,000.00 | $8,639.91 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,924.34 / $3,924.34 / $3,924.34
| Professional | | $3,924.34 | $3,924.34 | $3,924.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,774.60 / $7,432.27 / $16,695.66
| Facility | | $4,774.60 | $7,432.27 | $16,695.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,370.63 / $5,373.36 / $11,379.02
| Professional | | $2,370.63 | $5,373.36 | $11,379.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,993.56 / $6,792.12 / $9,559.28
| Professional | | $2,993.56 | $6,792.12 | $9,559.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,681.77 / $1,681.77 / $1,681.77
| Facility | | $1,681.77 | $1,681.77 | $1,681.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $3,622.46 / $20,778.90
| Facility | | $0.02 | $3,622.46 | $20,778.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.03 / $20,778.90 / $32,350.60
| Professional | | $0.03 | $20,778.90 | $32,350.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,446.18 / $7,546.80 / $10,062.40
| Professional | | $7,446.18 | $7,546.80 | $10,062.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.09 / $8,370.28 / $16,695.66
| Facility | | $4,897.09 | $8,370.28 | $16,695.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,648.91 / $5,385.70 / $11,379.02
| Professional | | $2,648.91 | $5,385.70 | $11,379.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,031.20 / $5,031.20 / $5,534.32
| Facility | | $5,031.20 | $5,031.20 | $5,534.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,031.20 / $5,031.20 / $5,534.32
| Professional | | $5,031.20 | $5,031.20 | $5,534.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,113.10 / $3,018.72 / $7,546.80
| Professional | | $2,113.10 | $3,018.72 | $7,546.80 |