- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,184.40 / $20,798.20 / $33,805.90
| Facility | | $12,184.40 | $20,798.20 | $33,805.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,231.00 / $18,928.62 / $23,779.60
| Facility | | $11,231.00 | $18,928.62 | $23,779.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,448.01 / $16,525.22 / $26,070.14
| Facility | | $10,448.01 | $16,525.22 | $26,070.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,302.42 / $16,311.37 / $30,591.29
| Facility | | $9,302.42 | $16,311.37 | $30,591.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,164.00 / $17,122.97 / $23,880.74
| Facility | | $6,164.00 | $17,122.97 | $23,880.74 |