- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $602.56 / $3,467.37
| Facility | | $575.44 | $602.56 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $4,168.69 / $4,168.69 / $4,168.69
| Facility | 22 | $4,168.69 | $4,168.69 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Facility | AS | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,137.96 / $3,019.95
| Professional | | $1,621.81 | $2,137.96 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $416.87 / $1,230.27
| Facility | | $302.00 | $416.87 | $1,230.27 |