- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $209.68 / $209.68 / $272.58
| Facility | 26 | $209.68 | $209.68 | $272.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $833.16 / $833.16 / $4,916.95
| Professional | | $833.16 | $833.16 | $4,916.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $209.68 / $430.58 / $1,042.00
| Professional | 26 | $209.68 | $430.58 | $1,042.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $787.84 / $1,329.48 / $1,790.54
| Professional | | $787.84 | $1,329.48 | $1,790.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $201.72 / $340.41 / $458.45
| Professional | 26 | $201.72 | $340.41 | $458.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,601.62 / $1,995.59 / $2,244.62
| Professional | | $1,601.62 | $1,995.59 | $2,244.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $420.36 / $505.08 / $598.02
| Professional | 26 | $420.36 | $505.08 | $598.02 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2,151.76 / $2,151.76 / $2,151.76
| Facility | 26 | $2,151.76 | $2,151.76 | $2,151.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,101.13 / $1,767.22 / $2,351.42
| Professional | | $1,101.13 | $1,767.22 | $2,351.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $290.62 / $502.99 / $686.43
| Professional | 26 | $290.62 | $502.99 | $686.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,213.67 / $1,749.33 / $2,194.52
| Professional | | $1,213.67 | $1,749.33 | $2,194.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.57 / $890.60 / $1,712.70
| Professional | | $246.57 | $890.60 | $1,712.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,185.83 / $1,727.16 / $2,098.07
| Professional | | $1,185.83 | $1,727.16 | $2,098.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $312.97 / $515.89 / $553.73
| Professional | 26 | $312.97 | $515.89 | $553.73 |