- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $8,511.38 / $13,489.63
| Facility | | $6,025.60 | $8,511.38 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | 62 | $5,495.41 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,703.96 / $33,884.42 / $66,069.34
| Facility | | $25,703.96 | $33,884.42 | $66,069.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,288.25 / $9,772.37
| Facility | | $870.96 | $1,288.25 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $2,754.23
| Facility | 52 | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $691.83 / $691.83 / $691.83
| Facility | 53 | $691.83 | $691.83 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | 62 | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,778.28 / $2,398.83
| Professional | | $1,659.59 | $1,778.28 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $7,413.10 / $9,120.11
| Facility | | $6,309.57 | $7,413.10 | $9,120.11 |