- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $206.78 / $206.78 / $768.54
| Facility | 26 | $206.78 | $206.78 | $768.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $726.31 / $923.57 / $1,279.41
| Professional | | $726.31 | $923.57 | $1,279.41 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $315.02 / $663.22 / $1,421.72
| Facility | 26 | $315.02 | $663.22 | $1,421.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $806.62 / $1,272.83 / $3,412.88
| Professional | | $806.62 | $1,272.83 | $3,412.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,093.84 / $1,812.54 / $3,032.15
| Professional | | $1,093.84 | $1,812.54 | $3,032.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.13 / $939.41 / $1,679.60
| Professional | | $368.13 | $939.41 | $1,679.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,124.34 / $2,043.73 / $2,829.99
| Professional | | $1,124.34 | $2,043.73 | $2,829.99 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $662.35 / $662.35 / $1,421.72
| Facility | 26 | $662.35 | $662.35 | $1,421.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $981.32 / $1,413.59 / $5,608.27
| Professional | | $981.32 | $1,413.59 | $5,608.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $962.10 / $1,279.98 / $2,204.55
| Professional | | $962.10 | $1,279.98 | $2,204.55 |