- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $7,585.78 / $14,454.40
| Facility | | $4,265.80 | $7,585.78 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,365.16 / $8,511.38
| Facility | | $3,311.31 | $4,365.16 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,630.78 / $7,943.28
| Facility | | $1,819.70 | $3,630.78 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $6,456.54 / $6,456.54 / $6,456.54
| Facility | 62 | $6,456.54 | $6,456.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $5,128.61 / $7,079.46
| Professional | | $4,365.16 | $5,128.61 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $4,365.16 / $8,128.31
| Facility | | $1,174.90 | $4,365.16 | $8,128.31 |