- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $6,456.54 / $10,715.19
| Facility | | $1,949.84 | $6,456.54 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $602.56 / $2,951.21
| Facility | | $575.44 | $602.56 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | 22 | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $295.12 / $295.12 / $295.12
| Facility | AS | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,862.09 / $2,630.27
| Professional | | $1,412.54 | $1,862.09 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,238.72 / $6,165.95
| Facility | | $1,548.82 | $2,238.72 | $6,165.95 |