- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $132.38 / $158.78 / $230.40
| Facility | 26 | $132.38 | $158.78 | $230.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $706.23 / $979.75 / $1,971.47
| Professional | | $706.23 | $979.75 | $1,971.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.30 / $765.12 / $2,046.41
| Professional | | $585.30 | $765.12 | $2,046.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.00 / $1,095.82 / $1,278.82
| Professional | | $183.00 | $1,095.82 | $1,278.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $146.22 / $146.22 / $146.22
| Facility | 26 | $146.22 | $146.22 | $146.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $864.06 / $1,267.15 / $2,862.44
| Professional | | $864.06 | $1,267.15 | $2,862.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $856.12 / $1,141.49 / $1,645.65
| Professional | | $856.12 | $1,141.49 | $1,645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $685.45 / $827.69 / $1,462.26
| Professional | | $685.45 | $827.69 | $1,462.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $146.22 / $146.22 / $146.22
| Facility | 26 | $146.22 | $146.22 | $146.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $886.80 / $1,250.19 / $2,447.41
| Professional | | $886.80 | $1,250.19 | $2,447.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $821.46 / $1,083.22 / $2,239.76
| Professional | | $821.46 | $1,083.22 | $2,239.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $174.76 / $174.76 / $471.11
| Facility | 26 | $174.76 | $174.76 | $471.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $713.16 / $1,160.43 / $2,142.96
| Professional | | $713.16 | $1,160.43 | $2,142.96 |