- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $107.64 / $141.54 / $172.27
| Facility | 26 | $107.64 | $141.54 | $172.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $684.86 / $767.09 / $832.24
| Professional | | $684.86 | $767.09 | $832.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $611.46 / $659.45 / $743.92
| Professional | TC | $611.46 | $659.45 | $743.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $711.55 / $941.75 / $1,046.39
| Professional | | $711.55 | $941.75 | $1,046.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $612.77 / $811.02 / $901.13
| Professional | TC | $612.77 | $811.02 | $901.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.49 / $1,121.06 / $1,510.41
| Professional | | $396.49 | $1,121.06 | $1,510.41 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $294.41 / $953.27 / $1,317.59
| Professional | TC | $294.41 | $953.27 | $1,317.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.16 / $861.34 / $1,559.07
| Professional | | $323.16 | $861.34 | $1,559.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $243.28 / $760.05 / $1,431.86
| Professional | TC | $243.28 | $760.05 | $1,431.86 |