- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $467.74 / $467.74 / $467.74
| Facility | 26 | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,348.96 / $1,949.84
| Professional | | $977.24 | $1,348.96 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $331.13 / $416.87 / $912.01
| Professional | 26 | $331.13 | $416.87 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,819.70 / $2,187.76
| Professional | | $1,621.81 | $1,819.70 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $512.86 / $562.34 / $676.08
| Professional | 26 | $512.86 | $562.34 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $870.96 / $2,454.71
| Professional | | $32.36 | $870.96 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $5,248.07
| Facility | 26 | $5,248.07 | $5,248.07 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,019.95 / $3,311.31
| Professional | | $2,344.23 | $3,019.95 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $691.83 / $1,023.29 / $2,238.72
| Professional | 26 | $691.83 | $1,023.29 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,089.30 / $2,951.21
| Professional | | $1,148.15 | $2,089.30 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $354.81 / $660.69 / $933.25
| Professional | 26 | $354.81 | $660.69 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,288.25 / $2,041.74
| Professional | | $588.84 | $1,288.25 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,584.89 / $1,905.46
| Professional | | $1,071.52 | $1,584.89 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $371.54 / $478.63 / $588.84
| Professional | 26 | $371.54 | $478.63 | $588.84 |