- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $374.00 / $374.01 / $463.77
| Facility | 26 | $374.00 | $374.01 | $463.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,241.65 / $1,244.89 / $3,450.92
| Professional | | $1,241.65 | $1,244.89 | $3,450.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $357.26 / $399.99 / $1,066.33
| Professional | 26 | $357.26 | $399.99 | $1,066.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $363.37 / $363.37 / $605.05
| Professional | 26 | $363.37 | $363.37 | $605.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $906.87 / $1,130.74 / $3,024.60
| Professional | | $906.87 | $1,130.74 | $3,024.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $338.02 / $794.71 / $1,397.34
| Professional | 26 | $338.02 | $794.71 | $1,397.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,293.69 / $1,664.11 / $2,984.38
| Professional | | $1,293.69 | $1,664.11 | $2,984.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $422.41 / $530.72 / $930.49
| Professional | 26 | $422.41 | $530.72 | $930.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $419.46 / $490.13 / $650.16
| Facility | 26 | $419.46 | $490.13 | $650.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,266.50 / $2,266.50 / $2,266.50
| Professional | | $2,266.50 | $2,266.50 | $2,266.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.34 / $898.16 / $1,575.33
| Professional | | $341.34 | $898.16 | $1,575.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,173.04 / $1,600.79 / $2,603.91
| Professional | | $1,173.04 | $1,600.79 | $2,603.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $364.18 / $479.00 / $779.42
| Professional | 26 | $364.18 | $479.00 | $779.42 |