- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $343.64 / $415.65 / $623.48
| Facility | 26 | $343.64 | $415.65 | $623.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $904.58 / $1,297.58 / $1,307.13
| Professional | | $904.58 | $1,297.58 | $1,307.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $294.74 / $395.66 / $424.42
| Professional | 26 | $294.74 | $395.66 | $424.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,159.60 / $1,534.78 / $1,534.78
| Professional | | $1,159.60 | $1,534.78 | $1,534.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $362.87 / $480.27 / $480.27
| Professional | 26 | $362.87 | $480.27 | $480.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,554.91 / $1,836.19 / $2,414.38
| Professional | | $1,554.91 | $1,836.19 | $2,414.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $474.94 / $571.27 / $729.38
| Professional | 26 | $474.94 | $571.27 | $729.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,043.56 / $1,392.01 / $2,311.07
| Professional | | $1,043.56 | $1,392.01 | $2,311.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $315.06 / $433.00 / $688.30
| Professional | 26 | $315.06 | $433.00 | $688.30 |