- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,168.69 / $7,943.28
| Facility | | $1,905.46 | $4,168.69 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $724.44 / $1,023.29
| Facility | | $630.96 | $724.44 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $1,230.27
| Facility | 22 | $1,230.27 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $102.33 / $102.33 / $102.33
| Facility | AS | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $676.08 / $954.99
| Professional | | $512.86 | $676.08 | $954.99 |
- 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 |