- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $6,066.00 / $12,765.09
| Facility | | $4,277.00 | $6,066.00 | $12,765.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,461.59 / $5,788.56 / $9,940.19
| Professional | | $3,461.59 | $5,788.56 | $9,940.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,987.74 / $7,801.75 / $10,274.15
| Facility | | $4,987.74 | $7,801.75 | $10,274.15 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $10,707.40 / $10,707.40 / $10,707.40
| Facility | 62 | $10,707.40 | $10,707.40 | $10,707.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,441.86 / $8,236.45 / $10,617.08
| Facility | | $5,441.86 | $8,236.45 | $10,617.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,847.00 / $7,305.00
| Facility | | $2,126.00 | $5,847.00 | $7,305.00 |