- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,786.30 / $7,079.46
| Facility | | $4,168.69 | $4,786.30 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,715.35 / $10,471.29
| Professional | | $2,570.40 | $3,715.35 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,248.07 / $8,912.51
| Facility | | $2,041.74 | $5,248.07 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $7,762.47 / $7,762.47 / $7,762.47
| Facility | 62 | $7,762.47 | $7,762.47 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,754.40 / $6,606.93 / $7,244.36
| Professional | | $5,754.40 | $6,606.93 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $11,481.54 / $19,498.45
| Facility | | $7,413.10 | $11,481.54 | $19,498.45 |