- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,151.40 / $25,862.80 / $42,038.00
| Facility | | $15,151.40 | $25,862.80 | $42,038.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,885.25 / $21,249.53 / $30,283.62
| Facility | | $14,885.25 | $21,249.53 | $30,283.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,943.83 / $20,549.30 / $32,418.51
| Facility | | $12,943.83 | $20,549.30 | $32,418.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,862.67 / $18,105.63 / $33,558.16
| Facility | | $9,862.67 | $18,105.63 | $33,558.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,842.00 / $21,462.61 / $29,522.25
| Facility | | $6,842.00 | $21,462.61 | $29,522.25 |