- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $616.60 / $645.65 / $724.44
| Facility | 26 | $616.60 | $645.65 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,445.44 / $2,238.72
| Professional | | $1,023.29 | $1,445.44 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $323.59 / $436.52 / $691.83
| Professional | 26 | $323.59 | $436.52 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Professional | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $309.03 / $407.38 / $524.81
| Professional | 26 | $309.03 | $407.38 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Professional | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,737.80 / $2,454.71
| Professional | | $1,318.26 | $1,737.80 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $416.87 / $562.34 / $794.33
| Professional | 26 | $416.87 | $562.34 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $2,691.53
| Facility | 26 | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,659.59 / $8,317.64
| Professional | | $1,288.25 | $1,659.59 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $380.19 / $549.54 / $2,290.87
| Professional | 26 | $380.19 | $549.54 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,659.59 / $2,238.72
| Professional | | $1,288.25 | $1,659.59 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $389.05 / $537.03 / $691.83
| Professional | 26 | $389.05 | $537.03 | $691.83 |