- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.04 / $3,714.14
| Facility | | $0.02 | $0.04 | $3,714.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,857.06 / $1,857.07 / $6,951.16
| Professional | | $1,857.06 | $1,857.07 | $6,951.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,710.69 / $6,496.11 / $10,291.67
| Facility | | $1,710.69 | $6,496.11 | $10,291.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,201.63 / $1,747.83 / $11,581.57
| Professional | | $1,201.63 | $1,747.83 | $11,581.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,039.14 / $2,039.14 / $2,039.14
| Facility | | $2,039.14 | $2,039.14 | $2,039.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,039.14 / $2,039.14 / $2,039.14
| Professional | | $2,039.14 | $2,039.14 | $2,039.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,261.74 / $2,075.55 / $2,655.61
| Facility | | $1,261.74 | $2,075.55 | $2,655.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,119.07 / $2,123.77 / $2,250.34
| Professional | | $2,119.07 | $2,123.77 | $2,250.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,119.07 / $2,123.77 / $2,250.34
| Professional | | $2,119.07 | $2,123.77 | $2,250.34 |