- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,612.54 / $7,612.54 / $7,612.54
| Facility | | $7,612.54 | $7,612.54 | $7,612.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,075.03 / $5,075.03 / $15,850.69
| Professional | | $5,075.03 | $5,075.03 | $15,850.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,456.92 / $5,821.21 / $8,577.84
| Facility | | $5,456.92 | $5,821.21 | $8,577.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,839.43 / $19,839.43 / $19,839.43
| Professional | | $19,839.43 | $19,839.43 | $19,839.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,000.00 / $16,000.00 / $19,500.00
| Professional | | $15,000.00 | $16,000.00 | $19,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,375.22 / $5,451.32 / $6,562.84
| Facility | | $4,375.22 | $5,451.32 | $6,562.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,911.94 / $5,911.94 / $5,911.94
| Professional | | $5,911.94 | $5,911.94 | $5,911.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,047.41 / $22,936.04 / $22,936.04
| Facility | | $21,047.41 | $22,936.04 | $22,936.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,075.03 / $5,075.03 / $5,075.03
| Facility | | $5,075.03 | $5,075.03 | $5,075.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29,581.50 / $42,789.78 / $44,774.45
| Professional | | $29,581.50 | $42,789.78 | $44,774.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,601.70 / $5,601.70 / $5,601.70
| Facility | | $5,601.70 | $5,601.70 | $5,601.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,075.03 / $5,075.03 / $5,075.03
| Facility | | $5,075.03 | $5,075.03 | $5,075.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,911.94 / $5,911.94 / $5,911.94
| Professional | | $5,911.94 | $5,911.94 | $5,911.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,744.94 / $3,659.92 / $5,182.45
| Professional | | $2,744.94 | $3,659.92 | $5,182.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,298.52 / $4,298.52 / $4,298.52
| Professional | | $4,298.52 | $4,298.52 | $4,298.52 |