- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.44 / $217.44 / $1,400.00
| Facility | | $217.44 | $217.44 | $1,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.86 / $249.73 / $272.08
| Facility | | $215.86 | $249.73 | $272.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $232.31 / $232.31 / $232.31
| Facility | | $232.31 | $232.31 | $232.31 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $140.04 / $140.04 / $140.04
| Facility | 62 | $140.04 | $140.04 | $140.04 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $22.41 / $22.41 / $22.41
| Facility | AS | $22.41 | $22.41 | $22.41 |