- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $278.11 / $278.11 / $665.46
| Facility | 26 | $278.11 | $278.11 | $665.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $980.03 / $1,117.28 / $1,350.49
| Professional | | $980.03 | $1,117.28 | $1,350.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $214.52 / $214.52 / $214.52
| Facility | 26 | $214.52 | $214.52 | $214.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,408.80 / $2,336.41 / $3,627.53
| Professional | | $1,408.80 | $2,336.41 | $3,627.53 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $627.49 / $889.85 / $2,140.66
| Facility | 26 | $627.49 | $889.85 | $2,140.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,927.45 / $3,132.43 / $4,191.63
| Professional | | $1,927.45 | $3,132.43 | $4,191.63 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $510.10 / $813.54 / $1,685.56
| Facility | 26 | $510.10 | $813.54 | $1,685.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,629.31 / $2,615.04 / $3,728.40
| Professional | | $1,629.31 | $2,615.04 | $3,728.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,276.50 / $2,258.08 / $3,887.61
| Professional | | $1,276.50 | $2,258.08 | $3,887.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.87 / $2,258.08 / $3,828.32
| Professional | | $1,318.87 | $2,258.08 | $3,828.32 |