- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $5,549.00 / $11,100.08
| Facility | | $4,277.00 | $5,549.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.14 / $623.96 / $1,519.36
| Professional | | $401.14 | $623.96 | $1,519.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $534.42 / $1,026.00 / $1,878.65
| Facility | | $534.42 | $1,026.00 | $1,878.65 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,174.16 / $1,174.16 / $1,174.16
| Facility | 62 | $1,174.16 | $1,174.16 | $1,174.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $638.86 / $957.29 / $1,237.08
| Facility | | $638.86 | $957.29 | $1,237.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,607.00 / $2,126.00
| Facility | | $1,204.00 | $1,607.00 | $2,126.00 |