- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.05 / $11,192.10
| Facility | | $0.02 | $0.05 | $11,192.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,387.44 / $17,425.00 / $17,425.00
| Professional | | $3,387.44 | $17,425.00 | $17,425.00 |
- 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
- $2,113.76 / $2,113.76 / $2,113.76
| Professional | | $2,113.76 | $2,113.76 | $2,113.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,571.75 / $4,003.22 / $8,992.73
| Facility | | $2,571.75 | $4,003.22 | $8,992.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,276.88 / $2,894.24 / $6,129.04
| Professional | | $1,276.88 | $2,894.24 | $6,129.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,612.42 / $3,658.43 / $5,148.91
| Professional | | $1,612.42 | $3,658.43 | $5,148.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,681.78 / $1,681.78 / $1,681.78
| Facility | | $1,681.78 | $1,681.78 | $1,681.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $1,951.16 / $11,192.10
| Facility | | $0.02 | $1,951.16 | $11,192.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.03 / $11,192.10 / $17,425.00
| Professional | | $0.03 | $11,192.10 | $17,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,010.73 / $4,064.93 / $5,419.90
| Professional | | $4,010.73 | $4,064.93 | $5,419.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,637.77 / $4,508.47 / $8,992.73
| Facility | | $2,637.77 | $4,508.47 | $8,992.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,426.81 / $2,900.88 / $6,129.04
| Professional | | $1,426.81 | $2,900.88 | $6,129.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,709.95 / $2,709.95 / $2,980.95
| Facility | | $2,709.95 | $2,709.95 | $2,980.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,709.95 / $2,709.95 / $2,980.95
| Professional | | $2,709.95 | $2,709.95 | $2,980.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,138.18 / $1,625.97 / $4,064.93
| Professional | | $1,138.18 | $1,625.97 | $4,064.93 |