- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,370.97 / $1,446.29 / $7,746.69
| Professional | | $1,370.97 | $1,446.29 | $7,746.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $632.54 / $632.54 / $2,129.48
| Professional | | $632.54 | $632.54 | $2,129.48 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $632.54 / $632.54 / $751.88
| Facility | 26 | $632.54 | $632.54 | $751.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,546.75 / $2,129.48 / $3,275.46
| Professional | | $1,546.75 | $2,129.48 | $3,275.46 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $632.54 / $632.54 / $751.88
| Facility | 26 | $632.54 | $632.54 | $751.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,368.73 / $1,939.07 / $3,036.88
| Professional | | $1,368.73 | $1,939.07 | $3,036.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,132.00 / $2,418.98 / $2,870.00
| Professional | | $2,132.00 | $2,418.98 | $2,870.00 |