- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $741.31 / $741.31 / $1,412.54
| Facility | 26 | $741.31 | $741.31 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,621.81 / $3,311.31
| Professional | | $1,258.93 | $1,621.81 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,238.72 / $7,413.10
| Professional | | $1,348.96 | $2,238.72 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $1,000.00 / $1,174.90 / $1,862.09
| Facility | 26 | $1,000.00 | $1,174.90 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,890.45 / $4,786.30
| Professional | | $2,187.76 | $3,890.45 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,235.94 / $3,890.45
| Professional | | $2,398.83 | $3,235.94 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,754.23 / $7,762.47
| Professional | | $1,659.59 | $2,754.23 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $58.88 / $3,090.30
| Professional | | $32.36 | $58.88 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,162.28 / $4,897.79
| Professional | | $2,570.40 | $3,162.28 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $891.25 / $891.25 / $3,630.78
| Facility | 26 | $891.25 | $891.25 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $6,918.31 / $9,120.11
| Professional | | $1,949.84 | $6,918.31 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,456.54 / $9,332.54 / $10,232.93
| Professional | | $6,456.54 | $9,332.54 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,754.23 / $6,165.95
| Professional | | $1,621.81 | $2,754.23 | $6,165.95 |