- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $5,091.00 / $7,120.36
| Facility | | $4,146.00 | $5,091.00 | $7,120.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,495.77 / $4,009.75 / $10,432.36
| Professional | | $2,495.77 | $4,009.75 | $10,432.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,757.98 / $6,175.59 / $8,328.35
| Facility | | $2,757.98 | $6,175.59 | $8,328.35 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $7,694.91 / $7,694.91 / $7,694.91
| Facility | 62 | $7,694.91 | $7,694.91 | $7,694.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,988.33 / $6,303.20 / $8,244.16
| Facility | | $4,988.33 | $6,303.20 | $8,244.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.31 / $4,133.00 / $11,732.00
| Facility | | $2,041.31 | $4,133.00 | $11,732.00 |