- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $409.41 / $409.41 / $418.80
| Facility | 26 | $409.41 | $409.41 | $418.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,794.29 / $1,860.59 / $9,969.37
| Professional | | $1,794.29 | $1,860.59 | $9,969.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $416.68 / $416.68 / $423.00
| Professional | 26 | $416.68 | $416.68 | $423.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $1,384.88 / $1,438.95 / $8,581.37
| Professional | TC | $1,384.88 | $1,438.95 | $8,581.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,798.00 / $6,814.00 / $6,814.00
| Professional | | $3,798.00 | $6,814.00 | $6,814.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $863.00 / $1,549.00 / $1,549.00
| Professional | 26 | $863.00 | $1,549.00 | $1,549.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $2,935.00 / $5,265.00 / $5,265.00
| Professional | TC | $2,935.00 | $5,265.00 | $5,265.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,529.51 / $2,529.96 / $5,375.45
| Professional | | $2,529.51 | $2,529.96 | $5,375.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $541.19 / $541.65 / $1,075.65
| Professional | 26 | $541.19 | $541.65 | $1,075.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $1,988.32 / $2,090.48 / $5,302.75
| Professional | TC | $1,988.32 | $2,090.48 | $5,302.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,480.91 / $3,240.60 / $6,587.90
| Professional | | $2,480.91 | $3,240.60 | $6,587.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $475.12 / $719.39 / $1,298.13
| Professional | 26 | $475.12 | $719.39 | $1,298.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $1,988.63 / $2,731.85 / $5,353.68
| Professional | TC | $1,988.63 | $2,731.85 | $5,353.68 |