- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $7,079.46 / $20,892.96
| Facility | | $2,691.53 | $7,079.46 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $6,456.54 / $11,481.54
| Facility | | $6,309.57 | $6,456.54 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $8,511.38 / $13,489.63
| Facility | | $5,370.32 | $8,511.38 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,309.57 / $19,054.61
| Facility | | $4,570.88 | $6,309.57 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $6,165.95 / $11,481.54
| Facility | | $3,981.07 | $6,165.95 | $11,481.54 |