- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $278.32 / $15,221.80 / $15,221.80
| Facility | 26 | $278.32 | $15,221.80 | $15,221.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,006.37 / $1,009.59 / $2,794.48
| Professional | | $1,006.37 | $1,009.59 | $2,794.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $677.35 / $916.27 / $1,784.86
| Professional | | $677.35 | $916.27 | $1,784.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,050.58 / $1,360.05 / $2,426.06
| Professional | | $1,050.58 | $1,360.05 | $2,426.06 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $333.49 / $343.18 / $483.80
| Facility | 26 | $333.49 | $343.18 | $483.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,266.50 / $2,266.50 / $2,266.50
| Professional | | $2,266.50 | $2,266.50 | $2,266.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.44 / $749.75 / $1,308.23
| Professional | | $271.44 | $749.75 | $1,308.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $973.40 / $1,299.04 / $2,813.61
| Professional | | $973.40 | $1,299.04 | $2,813.61 |