- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $7,943.28 / $14,454.40
| Facility | | $616.60 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $8,317.64 / $16,218.10
| Facility | | $6,456.54 | $8,317.64 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $524.81 / $1,000.00
| Facility | | $309.03 | $524.81 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | 62 | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $158.49 / $158.49 / $158.49
| Facility | AS | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $794.33 / $1,096.48
| Professional | | $645.65 | $794.33 | $1,096.48 |
- 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 |