- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,240.00 / $5,088.00 / $9,120.00
| Facility | | $2,240.00 | $5,088.00 | $9,120.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,696.00 / $2,104.00 / $2,720.00
| Professional | | $1,696.00 | $2,104.00 | $2,720.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.49 / $7.49 / $1,920.00
| Professional | | $7.49 | $7.49 | $1,920.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,840.00 / $6,760.00 / $11,520.14
| Facility | | $3,840.00 | $6,760.00 | $11,520.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,897.99 / $15,424.00 / $15,424.00
| Professional | | $3,897.99 | $15,424.00 | $15,424.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $3,840.00 / $7,200.00
| Facility | | $294.00 | $3,840.00 | $7,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,360.00 / $4,192.00 / $6,944.00
| Professional | | $3,360.00 | $4,192.00 | $6,944.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,720.00 / $3,160.43 / $5,802.54
| Professional | | $2,720.00 | $3,160.43 | $5,802.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $6,760.00 / $11,520.14
| Facility | | $597.00 | $6,760.00 | $11,520.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,080.00 / $3,456.00 / $7,360.00
| Professional | | $2,080.00 | $3,456.00 | $7,360.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,344.00 / $1,920.00 / $5,023.52
| Professional | | $1,344.00 | $1,920.00 | $5,023.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,267.90 / $3,679.92 / $3,679.92
| Facility | | $3,267.90 | $3,679.92 | $3,679.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,720.00 / $3,267.90 / $3,846.13
| Professional | | $2,720.00 | $3,267.90 | $3,846.13 |