- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,042.70 / $39,333.00 / $63,932.70
| Facility | | $23,042.70 | $39,333.00 | $63,932.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,019.51 / $29,739.47 / $42,211.23
| Facility | | $21,019.51 | $29,739.47 | $42,211.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,758.98 / $31,252.03 / $49,303.10
| Facility | | $19,758.98 | $31,252.03 | $49,303.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,632.20 / $25,255.98 / $49,723.95
| Facility | | $12,632.20 | $25,255.98 | $49,723.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,842.00 / $32,641.01 / $44,898.38
| Facility | | $6,842.00 | $32,641.01 | $44,898.38 |