- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $376.27 / $414.66 / $1,151.83
| Facility | 26 | $376.27 | $414.66 | $1,151.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,330.00 / $1,465.71 / $2,714.28
| Professional | | $1,330.00 | $1,465.71 | $2,714.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,384.28 / $1,811.10 / $2,964.67
| Professional | | $1,384.28 | $1,811.10 | $2,964.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,656.11 / $2,078.71 / $3,138.82
| Professional | | $1,656.11 | $2,078.71 | $3,138.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2,974.88 / $3,621.28 / $3,718.96
| Facility | 26 | $2,974.88 | $3,621.28 | $3,718.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,066.29 / $9,066.29 / $11,086.50
| Professional | | $9,066.29 | $9,066.29 | $11,086.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,335.58 / $1,859.83 / $3,118.43
| Professional | | $1,335.58 | $1,859.83 | $3,118.43 |