- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $326.38 / $326.38 / $326.38
| Facility | 26 | $326.38 | $326.38 | $326.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,072.31 / $1,204.23 / $2,225.01
| Professional | | $1,072.31 | $1,204.23 | $2,225.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $324.29 / $448.84 / $1,399.50
| Professional | 26 | $324.29 | $448.84 | $1,399.50 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $708.22 / $786.04 / $2,401.92
| Facility | 26 | $708.22 | $786.04 | $2,401.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $938.26 / $2,014.19 / $7,402.64
| Professional | | $938.26 | $2,014.19 | $7,402.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $294.06 / $646.74 / $2,032.70
| Professional | 26 | $294.06 | $646.74 | $2,032.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,133.13 / $2,597.19 / $4,120.79
| Professional | | $2,133.13 | $2,597.19 | $4,120.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $594.00 / $686.81 / $1,089.72
| Professional | 26 | $594.00 | $686.81 | $1,089.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.49 / $729.24 / $1,647.55
| Professional | | $236.49 | $729.24 | $1,647.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,312.77 / $2,625.54 / $4,266.50
| Professional | | $1,312.77 | $2,625.54 | $4,266.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $398.54 / $756.03 / $1,003.13
| Professional | 26 | $398.54 | $756.03 | $1,003.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.93 / $509.85 / $966.64
| Professional | | $254.93 | $509.85 | $966.64 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2,401.92 / $2,401.92 / $2,924.64
| Facility | 26 | $2,401.92 | $2,401.92 | $2,924.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,529.39 / $2,438.00 / $7,402.64
| Professional | | $1,529.39 | $2,438.00 | $7,402.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $424.30 / $696.09 / $2,032.70
| Professional | 26 | $424.30 | $696.09 | $2,032.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,442.94 / $1,867.79 / $4,329.56
| Professional | | $1,442.94 | $1,867.79 | $4,329.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $406.10 / $582.61 / $1,254.89
| Professional | 26 | $406.10 | $582.61 | $1,254.89 |