- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $436.52 / $691.83 / $977.24
| Facility | 26 | $436.52 | $691.83 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,621.81 / $4,265.80
| Professional | | $1,230.27 | $1,621.81 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,995.26 / $3,388.44
| Professional | | $1,445.44 | $1,995.26 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,412.54 / $2,137.96
| Professional | | $1,258.93 | $1,412.54 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,137.96 / $3,019.95
| Professional | | $1,348.96 | $2,137.96 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2,951.21 / $3,715.35 / $3,715.35
| Facility | 26 | $2,951.21 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,290.87 / $9,120.11
| Professional | | $1,258.93 | $2,290.87 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,137.96 / $3,311.31
| Professional | | $1,318.26 | $2,137.96 | $3,311.31 |