- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $534.08 / $699.47 / $699.47
| Facility | 26 | $534.08 | $699.47 | $699.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,143.33 / $1,346.66 / $2,768.44
| Professional | | $1,143.33 | $1,346.66 | $2,768.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $360.94 / $433.69 / $1,893.00
| Professional | 26 | $360.94 | $433.69 | $1,893.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $310.11 / $430.71 / $710.16
| Professional | 26 | $310.11 | $430.71 | $710.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $890.56 / $1,187.42 / $1,484.27
| Professional | | $890.56 | $1,187.42 | $1,484.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $271.14 / $361.52 / $451.90
| Professional | 26 | $271.14 | $361.52 | $451.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,284.78 / $1,504.17 / $2,243.54
| Professional | | $1,284.78 | $1,504.17 | $2,243.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $380.02 / $458.86 / $664.80
| Professional | 26 | $380.02 | $458.86 | $664.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2,693.76 / $2,693.76 / $3,363.92
| Facility | 26 | $2,693.76 | $2,693.76 | $3,363.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,208.79 / $1,431.30 / $2,950.76
| Professional | | $1,208.79 | $1,431.30 | $2,950.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $358.05 / $448.79 / $924.31
| Professional | 26 | $358.05 | $448.79 | $924.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,180.48 / $1,391.93 / $2,424.17
| Professional | | $1,180.48 | $1,391.93 | $2,424.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $358.05 / $423.15 / $694.43
| Professional | 26 | $358.05 | $423.15 | $694.43 |