- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.05 / $0.06 / $1,636.35
| Facility | | $0.05 | $0.06 | $1,636.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,636.35 / $2,688.30 / $15,031.10
| Professional | | $1,636.35 | $2,688.30 | $15,031.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,407.78 / $2,501.29 / $14,391.56
| Facility | | $2,407.78 | $2,501.29 | $14,391.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,337.65 / $2,454.53 / $3,225.96
| Professional | | $2,337.65 | $2,454.53 | $3,225.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,248.43 / $5,758.79 / $13,328.79
| Facility | | $4,248.43 | $5,758.79 | $13,328.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,061.24 / $1,367.53 / $2,759.23
| Professional | | $1,061.24 | $1,367.53 | $2,759.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,208.59 / $2,337.65 / $3,506.48
| Facility | | $2,208.59 | $2,337.65 | $3,506.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,285.71 / $1,285.71 / $1,285.71
| Professional | | $1,285.71 | $1,285.71 | $1,285.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $981.81 / $1,285.71 / $2,128.69
| Professional | | $981.81 | $1,285.71 | $2,128.69 |