- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,981.07 / $8,317.64
| Facility | | $1,047.13 | $3,981.07 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $549.54 / $1,174.90
| Professional | | $457.09 | $549.54 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,258.93 / $57,543.99
| Facility | | $1,174.90 | $1,258.93 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $562.34 / $912.01
| Professional | | $537.03 | $562.34 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $912.01
| Facility | | $912.01 | $912.01 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $588.84 / $1,047.13
| Professional | | $416.87 | $588.84 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $831.76 / $1,071.52
| Professional | | $616.60 | $831.76 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $645.65 / $912.01
| Professional | | $467.74 | $645.65 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $707.95
| Facility | | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $3,090.30 / $8,317.64
| Facility | | $954.99 | $3,090.30 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $707.95 / $1,584.89
| Professional | | $478.63 | $707.95 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $1,096.48
| Facility | | $524.81 | $524.81 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $562.34 / $1,096.48
| Professional | | $537.03 | $562.34 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $524.81
| Facility | | $416.87 | $416.87 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $512.86 / $645.65
| Professional | | $416.87 | $512.86 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $676.08 / $3,890.45
| Facility | | $223.87 | $676.08 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $575.44 / $977.24
| Professional | | $426.58 | $575.44 | $977.24 |