- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $437.54 / $768.65 / $2,365.60
| Facility | 26 | $437.54 | $768.65 | $2,365.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $709.36 / $854.57 / $1,161.56
| Professional | | $709.36 | $854.57 | $1,161.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $380.27 / $491.36 / $618.74
| Professional | 26 | $380.27 | $491.36 | $618.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $425.45 / $641.64 / $644.27
| Professional | 26 | $425.45 | $641.64 | $644.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.70 / $1,050.79 / $1,706.66
| Professional | | $355.70 | $1,050.79 | $1,706.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $398.04 / $670.89 / $1,038.16
| Professional | 26 | $398.04 | $670.89 | $1,038.16 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $720.94 / $720.94 / $720.94
| Facility | 26 | $720.94 | $720.94 | $720.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $832.27 / $1,253.15 / $1,998.27
| Professional | | $832.27 | $1,253.15 | $1,998.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $441.39 / $701.48 / $1,158.44
| Professional | 26 | $441.39 | $701.48 | $1,158.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $3,401.60 / $4,284.56 / $4,331.35
| Facility | 26 | $3,401.60 | $4,284.56 | $4,331.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,280.00 / $6,280.00 / $7,786.43
| Professional | | $6,280.00 | $6,280.00 | $7,786.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5,024.00 / $5,024.00 / $5,024.00
| Professional | 26 | $5,024.00 | $5,024.00 | $5,024.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $807.27 / $985.68 / $2,340.98
| Professional | | $807.27 | $985.68 | $2,340.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $453.85 / $611.82 / $1,207.23
| Professional | 26 | $453.85 | $611.82 | $1,207.23 |