- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $367.41 / $367.41 / $367.41
| Facility | 26 | $367.41 | $367.41 | $367.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,195.30 / $1,296.86 / $1,973.73
| Professional | | $1,195.30 | $1,296.86 | $1,973.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $357.26 / $367.41 / $526.80
| Professional | 26 | $357.26 | $367.41 | $526.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,287.81 / $2,750.78 / $3,043.02
| Professional | | $2,287.81 | $2,750.78 | $3,043.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $701.91 / $843.95 / $925.29
| Professional | 26 | $701.91 | $843.95 | $925.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,664.11 / $2,304.89 / $3,720.54
| Professional | | $1,664.11 | $2,304.89 | $3,720.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $505.91 / $655.46 / $1,058.04
| Professional | 26 | $505.91 | $655.46 | $1,058.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,321.96 / $2,379.10 / $3,120.17
| Professional | | $1,321.96 | $2,379.10 | $3,120.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $407.68 / $695.91 / $868.08
| Professional | 26 | $407.68 | $695.91 | $868.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,441.38 / $2,402.30 / $3,120.17
| Professional | | $1,441.38 | $2,402.30 | $3,120.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $444.73 / $741.22 / $868.08
| Professional | 26 | $444.73 | $741.22 | $868.08 |