- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $7,943.28 / $14,454.40
| Facility | | $549.54 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $10,232.93 / $19,952.62
| Facility | | $7,762.47 | $10,232.93 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $501.19 / $8,128.31
| Facility | | $281.84 | $501.19 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $489.78 / $912.01 / $912.01
| Facility | 62 | $489.78 | $912.01 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $77.62 / $147.91 / $147.91
| Facility | AS | $77.62 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $724.44 / $1,000.00
| Professional | | $588.84 | $724.44 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $8,128.31 / $10,000.00
| Facility | | $7,079.46 | $8,128.31 | $10,000.00 |