- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $328.34 / $328.34 / $328.34
| Facility | 26 | $328.34 | $328.34 | $328.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,143.02 / $1,143.02 / $6,918.61
| Professional | | $1,143.02 | $1,143.02 | $6,918.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $328.34 / $543.23 / $1,533.00
| Professional | 26 | $328.34 | $543.23 | $1,533.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,080.93 / $1,824.06 / $2,456.65
| Professional | | $1,080.93 | $1,824.06 | $2,456.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $315.43 / $532.27 / $716.88
| Professional | 26 | $315.43 | $532.27 | $716.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,252.55 / $2,765.30 / $3,076.87
| Professional | | $2,252.55 | $2,765.30 | $3,076.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $657.33 / $788.97 / $925.03
| Professional | 26 | $657.33 | $788.97 | $925.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $3,363.92 / $3,363.92 / $3,363.92
| Facility | 26 | $3,363.92 | $3,363.92 | $3,363.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,552.45 / $2,511.07 / $3,341.16
| Professional | | $1,552.45 | $2,511.07 | $3,341.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $454.50 / $786.62 / $1,052.05
| Professional | 26 | $454.50 | $786.62 | $1,052.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.66 / $2,485.64 / $3,159.87
| Professional | | $1,737.66 | $2,485.64 | $3,159.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.08 / $1,224.14 / $2,354.11
| Professional | | $385.08 | $1,224.14 | $2,354.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,552.45 / $2,651.10 / $2,958.01
| Professional | | $1,552.45 | $2,651.10 | $2,958.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $454.50 / $779.65 / $865.99
| Professional | 26 | $454.50 | $779.65 | $865.99 |