- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,306.00 / $9,504.00 / $11,627.00
| Facility | | $2,306.00 | $9,504.00 | $11,627.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $10,268.00
| Professional | | $0.02 | $0.02 | $10,268.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $0.03
| Professional | | $0.02 | $0.02 | $0.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,648.86 / $12,648.86 / $148,498.50
| Facility | | $12,648.86 | $12,648.86 | $148,498.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.00 / $50.00 / $60.00
| Professional | | $40.00 | $50.00 | $60.00 |