- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $6,606.93 / $15,848.93
| Facility | | $645.65 | $6,606.93 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $524.81 / $1,047.13
| Professional | | $398.11 | $524.81 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $11,481.54 / $21,379.62
| Facility | | $5,011.87 | $11,481.54 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $457.09 / $1,174.90
| Professional | | $354.81 | $457.09 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $588.84
| Facility | | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $588.84
| Professional | | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $4,786.30 / $51,286.14
| Facility | | $34.67 | $4,786.30 | $51,286.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $741.31 / $1,949.84
| Professional | | $407.38 | $741.31 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $707.95 / $1,445.44
| Facility | | $446.68 | $707.95 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $562.34 / $776.25
| Professional | | $407.38 | $562.34 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $489.78 / $776.25
| Professional | | $309.03 | $489.78 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $50,118.72 / $75,857.76
| Facility | | $489.78 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $588.84 / $660.69
| Professional | | $467.74 | $588.84 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,168.69 / $9,332.54
| Facility | | $1,513.56 | $4,168.69 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $549.54 / $1,258.93
| Professional | | $389.05 | $549.54 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $524.81 / $588.84
| Facility | | $331.13 | $524.81 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $489.78 / $831.76
| Professional | | $309.03 | $489.78 | $831.76 |