- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $595.63 / $595.63 / $1,147.42
| Facility | 26 | $595.63 | $595.63 | $1,147.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,118.21 / $1,459.52 / $2,126.92
| Professional | | $1,118.21 | $1,459.52 | $2,126.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $307.20 / $438.94 / $1,723.23
| Professional | 26 | $307.20 | $438.94 | $1,723.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,098.50 / $2,185.13 / $7,857.79
| Professional | | $1,098.50 | $2,185.13 | $7,857.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $319.57 / $605.75 / $2,180.62
| Professional | 26 | $319.57 | $605.75 | $2,180.62 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $804.70 / $940.36 / $1,516.76
| Facility | 26 | $804.70 | $940.36 | $1,516.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,916.18 / $3,129.07 / $4,552.71
| Professional | | $1,916.18 | $3,129.07 | $4,552.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $572.27 / $886.86 / $1,282.78
| Professional | 26 | $572.27 | $886.86 | $1,282.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,300.22 / $2,332.90 / $6,306.32
| Professional | | $1,300.22 | $2,332.90 | $6,306.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $382.12 / $716.94 / $1,865.00
| Professional | 26 | $382.12 | $716.94 | $1,865.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.69 / $900.44 / $2,224.63
| Professional | | $266.69 | $900.44 | $2,224.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,347.15 / $2,881.94 / $3,997.14
| Professional | | $2,347.15 | $2,881.94 | $3,997.14 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $3,007.60 / $3,007.60 / $3,007.60
| Facility | 26 | $3,007.60 | $3,007.60 | $3,007.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,679.53 / $4,665.33 / $7,402.64
| Professional | | $1,679.53 | $4,665.33 | $7,402.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $476.01 / $1,322.28 / $2,032.70
| Professional | 26 | $476.01 | $1,322.28 | $2,032.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,934.92 / $7,689.44 / $7,689.44
| Professional | | $4,934.92 | $7,689.44 | $7,689.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $1,405.06 / $1,653.01 / $1,790.75
| Professional | 26 | $1,405.06 | $1,653.01 | $1,790.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,300.22 / $2,332.90 / $5,871.49
| Professional | | $1,300.22 | $2,332.90 | $5,871.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $382.12 / $728.44 / $1,777.16
| Professional | 26 | $382.12 | $728.44 | $1,777.16 |