- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $333.73 / $333.73 / $333.73
| Facility | 26 | $333.73 | $333.73 | $333.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,118.21 / $1,237.08 / $1,815.26
| Professional | | $1,118.21 | $1,237.08 | $1,815.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $320.61 / $358.49 / $1,463.00
| Professional | 26 | $320.61 | $358.49 | $1,463.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $257.14 / $257.14 / $257.14
| Facility | 26 | $257.14 | $257.14 | $257.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,565.06 / $2,595.23 / $4,029.37
| Professional | | $1,565.06 | $2,595.23 | $4,029.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $475.14 / $769.00 / $1,184.82
| Professional | 26 | $475.14 | $769.00 | $1,184.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $752.14 / $1,066.63 / $2,565.92
| Facility | 26 | $752.14 | $1,066.63 | $2,565.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.13 / $3,473.20 / $4,647.62
| Professional | | $2,137.13 | $3,473.20 | $4,647.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $602.16 / $978.61 / $1,309.52
| Professional | 26 | $602.16 | $978.61 | $1,309.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $611.44 / $975.16 / $2,020.41
| Facility | 26 | $611.44 | $975.16 | $2,020.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,806.56 / $2,899.52 / $4,134.00
| Professional | | $1,806.56 | $2,899.52 | $4,134.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $509.02 / $801.94 / $1,164.80
| Professional | 26 | $509.02 | $801.94 | $1,164.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,455.22 / $2,529.29 / $4,360.59
| Professional | | $1,455.22 | $2,529.29 | $4,360.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $419.80 / $708.61 / $1,277.88
| Professional | 26 | $419.80 | $708.61 | $1,277.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,455.22 / $2,450.15 / $4,124.35
| Professional | | $1,455.22 | $2,450.15 | $4,124.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $424.30 / $679.10 / $1,192.61
| Professional | 26 | $424.30 | $679.10 | $1,192.61 |