- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $2,754.23
| Facility | 26 | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $812.83 / $1,380.38
| Professional | | $588.84 | $812.83 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $426.58 / $524.81 / $1,698.24
| Professional | 26 | $426.58 | $524.81 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,071.52 / $1,905.46
| Professional | | $758.58 | $1,071.52 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $389.05 / $537.03 / $1,071.52
| Professional | 26 | $389.05 | $537.03 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,819.70 / $2,570.40
| Professional | | $1,174.90 | $1,819.70 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $575.44 / $977.24 / $1,258.93
| Professional | 26 | $575.44 | $977.24 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $977.24 / $1,479.11
| Professional | | $676.08 | $977.24 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $478.63 / $645.65 / $831.76
| Professional | 26 | $478.63 | $645.65 | $831.76 |