- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $154.88 / $446.68 / $645.65
| Facility | 26 | $154.88 | $446.68 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $977.24 / $2,290.87
| Professional | | $645.65 | $977.24 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $575.44 / $891.25 / $2,089.30
| Professional | TC | $575.44 | $891.25 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,621.81 / $2,187.76
| Professional | | $758.58 | $1,621.81 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $676.08 / $1,412.54 / $1,905.46
| Professional | TC | $676.08 | $1,412.54 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $1,174.90 / $2,238.72
| Professional | | $338.84 | $1,174.90 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $208.93 / $1,047.13 / $2,041.74
| Professional | TC | $208.93 | $1,047.13 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $660.69 / $1,412.54
| Professional | | $323.59 | $660.69 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $831.76 / $1,122.02 / $1,348.96
| Professional | TC | $831.76 | $1,122.02 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $1,174.90 / $1,995.26
| Professional | | $323.59 | $1,174.90 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $588.84 / $1,071.52 / $1,778.28
| Professional | TC | $588.84 | $1,071.52 | $1,778.28 |