- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $110.60 / $129.83 / $129.83
| Facility | 26 | $110.60 | $129.83 | $129.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $814.16 / $862.63 / $933.65
| Professional | | $814.16 | $862.63 | $933.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $730.06 / $773.52 / $841.81
| Professional | TC | $730.06 | $773.52 | $841.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.37 / $814.81 / $1,332.15
| Professional | | $527.37 | $814.81 | $1,332.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $392.49 / $728.25 / $1,200.06
| Professional | TC | $392.49 | $728.25 | $1,200.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.08 / $735.34 / $1,910.73
| Professional | | $300.08 | $735.34 | $1,910.73 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $193.58 / $737.21 / $1,678.51
| Professional | TC | $193.58 | $737.21 | $1,678.51 |