- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.06 / $0.06 / $1,218.00
| Facility | | $0.06 | $0.06 | $1,218.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.06 / $2,709.95 / $3,712.63
| Professional | | $0.06 | $2,709.95 | $3,712.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,883.31 / $1,883.31 / $1,883.31
| Facility | | $1,883.31 | $1,883.31 | $1,883.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $680.00 / $800.00
| Professional | | $100.00 | $680.00 | $800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,251.94 / $3,793.93 / $4,471.42
| Facility | | $3,251.94 | $3,793.93 | $4,471.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,116.44 / $3,658.43 / $5,419.90
| Professional | | $3,116.44 | $3,658.43 | $5,419.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,761.47 / $2,108.61 / $3,575.78
| Facility | | $1,761.47 | $2,108.61 | $3,575.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,237.02 / $2,865.07 / $13,061.96
| Professional | | $1,237.02 | $2,865.07 | $13,061.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,138.18 / $1,625.97 / $2,709.95
| Professional | | $1,138.18 | $1,625.97 | $2,709.95 |