- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $273.47 / $273.47 / $273.47
| Facility | 26 | $273.47 | $273.47 | $273.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.83 / $234.66 / $258.01
| Professional | | $197.83 | $234.66 | $258.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $157.38 / $184.01 / $211.75
| Professional | TC | $157.38 | $184.01 | $211.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.72 / $245.72 / $420.63
| Professional | | $245.72 | $245.72 | $420.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $136.43 / $194.90 / $194.90
| Professional | TC | $136.43 | $194.90 | $194.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.97 / $463.28 / $472.74
| Professional | | $255.97 | $463.28 | $472.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $203.02 / $372.00 / $384.84
| Professional | TC | $203.02 | $372.00 | $384.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.64 / $254.62 / $385.46
| Professional | | $168.64 | $254.62 | $385.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $135.35 / $184.42 / $309.36
| Professional | TC | $135.35 | $184.42 | $309.36 |