- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $380.19 / $616.60 / $1,659.59
| Facility | 26 | $380.19 | $616.60 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,238.72 / $8,511.38
| Professional | | $1,548.82 | $2,238.72 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $354.81 / $562.34 / $1,659.59
| Professional | 26 | $354.81 | $562.34 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $1,174.90 / $1,737.80 / $3,981.07
| Professional | TC | $1,174.90 | $1,737.80 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,238.72 / $4,365.16
| Professional | | $1,621.81 | $2,238.72 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $398.11 / $524.81 / $977.24
| Professional | 26 | $398.11 | $524.81 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $1,230.27 / $1,698.24 / $3,388.44
| Professional | TC | $1,230.27 | $1,698.24 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $102.33 / $588.84 / $1,698.24
| Facility | 26 | $102.33 | $588.84 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,691.53 / $5,370.32
| Professional | | $1,659.59 | $2,691.53 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $380.19 / $616.60 / $1,202.26
| Professional | 26 | $380.19 | $616.60 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $1,288.25 / $2,238.72 / $4,365.16
| Professional | TC | $1,288.25 | $2,238.72 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,344.23 / $4,168.69
| Professional | | $1,548.82 | $2,344.23 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $346.74 / $501.19 / $912.01
| Professional | 26 | $346.74 | $501.19 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $1,230.27 / $1,862.09 / $3,311.31
| Professional | TC | $1,230.27 | $1,862.09 | $3,311.31 |