- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $271.93 / $333.72 / $625.32
| Facility | 26 | $271.93 | $333.72 | $625.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $941.46 / $1,226.09 / $2,796.36
| Professional | | $941.46 | $1,226.09 | $2,796.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $790.41 / $1,033.22 / $2,485.87
| Professional | | $790.41 | $1,033.22 | $2,485.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.54 / $1,123.51 / $1,513.06
| Professional | | $389.54 | $1,123.51 | $1,513.06 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $311.56 / $311.56 / $311.56
| Facility | 26 | $311.56 | $311.56 | $311.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,113.91 / $1,704.79 / $3,651.58
| Professional | | $1,113.91 | $1,704.79 | $3,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $957.24 / $1,286.19 / $1,938.72
| Professional | | $957.24 | $1,286.19 | $1,938.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $856.97 / $957.24 / $1,708.82
| Professional | | $856.97 | $957.24 | $1,708.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $311.56 / $311.56 / $311.56
| Facility | 26 | $311.56 | $311.56 | $311.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,114.17 / $1,700.35 / $3,147.71
| Professional | | $1,114.17 | $1,700.35 | $3,147.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $931.38 / $1,284.17 / $2,585.46
| Professional | | $931.38 | $1,284.17 | $2,585.46 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $371.09 / $371.09 / $959.42
| Facility | 26 | $371.09 | $371.09 | $959.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $887.03 / $1,381.11 / $2,504.29
| Professional | | $887.03 | $1,381.11 | $2,504.29 |