- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,185.65 / $2,185.65 / $2,326.09
| Professional | | $2,185.65 | $2,185.65 | $2,326.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $405.68 / $414.95 / $414.95
| Professional | 26 | $405.68 | $414.95 | $414.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $1,770.70 / $1,770.70 / $1,920.41
| Professional | TC | $1,770.70 | $1,770.70 | $1,920.41 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2,348.58 / $2,348.58 / $2,348.58
| Facility | 26 | $2,348.58 | $2,348.58 | $2,348.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,293.69 / $2,293.69 / $7,813.46
| Professional | | $2,293.69 | $2,293.69 | $7,813.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $522.66 / $522.66 / $1,766.43
| Professional | 26 | $522.66 | $522.66 | $1,766.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $1,866.14 / $1,866.14 / $1,866.14
| Professional | TC | $1,866.14 | $1,866.14 | $1,866.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,451.28 / $2,760.25 / $7,813.46
| Professional | | $2,451.28 | $2,760.25 | $7,813.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $547.45 / $567.79 / $1,766.43
| Professional | 26 | $547.45 | $567.79 | $1,766.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $1,892.61 / $2,153.62 / $3,397.69
| Professional | TC | $1,892.61 | $2,153.62 | $3,397.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,451.28 / $2,760.25 / $7,813.46
| Professional | | $2,451.28 | $2,760.25 | $7,813.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $547.45 / $567.79 / $1,766.43
| Professional | 26 | $547.45 | $567.79 | $1,766.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $1,892.61 / $2,153.62 / $3,397.69
| Professional | TC | $1,892.61 | $2,153.62 | $3,397.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,133.35 / $2,514.44 / $8,311.45
| Professional | | $2,133.35 | $2,514.44 | $8,311.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $399.49 / $552.79 / $1,879.02
| Professional | 26 | $399.49 | $552.79 | $1,879.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $1,453.40 / $2,134.05 / $6,432.44
| Professional | TC | $1,453.40 | $2,134.05 | $6,432.44 |