- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $49.17 / $61.21 / $248.70
| Facility | 26 | $49.17 | $61.21 | $248.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.66 / $266.81 / $897.00
| Professional | | $150.66 | $266.81 | $897.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.93 / $62.08 / $209.44
| Professional | 26 | $41.93 | $62.08 | $209.44 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $64.55 / $108.06 / $402.88
| Professional | 52 | $64.55 | $108.06 | $402.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $103.73 / $202.05 / $534.00
| Professional | TC | $103.73 | $202.05 | $534.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.08 / $133.18 / $285.01
| Professional | | $115.08 | $133.18 | $285.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.98 / $43.47 / $91.08
| Professional | 26 | $29.98 | $43.47 | $91.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $116.96 / $167.56 / $167.56
| Professional | TC | $116.96 | $167.56 | $167.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.97 / $309.13 / $507.92
| Professional | | $169.97 | $309.13 | $507.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.84 / $71.91 / $132.55
| Professional | 26 | $49.84 | $71.91 | $132.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $119.21 / $237.31 / $382.87
| Professional | TC | $119.21 | $237.31 | $382.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.63 / $177.27 / $431.71
| Professional | | $115.63 | $177.27 | $431.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.95 / $52.29 / $122.71
| Professional | 26 | $37.95 | $52.29 | $122.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $99.42 / $126.24 / $302.95
| Professional | TC | $99.42 | $126.24 | $302.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $46.27 / $46.27 / $46.27
| Facility | 26 | $46.27 | $46.27 | $46.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.12 / $238.13 / $434.30
| Professional | | $119.12 | $238.13 | $434.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.21 / $58.58 / $115.54
| Professional | 26 | $29.21 | $58.58 | $115.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $83.27 / $180.23 / $335.43
| Professional | TC | $83.27 | $180.23 | $335.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.35 / $168.33 / $227.25
| Professional | | $123.35 | $168.33 | $227.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.77 / $45.18 / $60.99
| Professional | 26 | $35.77 | $45.18 | $60.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $87.58 / $123.16 / $166.27
| Professional | TC | $87.58 | $123.16 | $166.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.07 / $173.71 / $282.00
| Professional | | $131.07 | $173.71 | $282.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.92 / $54.22 / $94.58
| Professional | 26 | $39.92 | $54.22 | $94.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $94.93 / $142.40 / $230.90
| Professional | TC | $94.93 | $142.40 | $230.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $371.60 / $371.60 / $379.28
| Facility | 26 | $371.60 | $371.60 | $379.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,379.07 / $1,413.47 / $1,413.47
| Professional | | $1,379.07 | $1,413.47 | $1,413.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $333.52 / $333.52 / $333.52
| Professional | 26 | $333.52 | $333.52 | $333.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $1,220.00 / $1,220.00 / $1,220.00
| Professional | TC | $1,220.00 | $1,220.00 | $1,220.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $101.71
| Professional | | $32.34 | $32.34 | $101.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $46.27 / $46.27 / $46.27
| Facility | 26 | $46.27 | $46.27 | $46.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.17 / $260.25 / $406.89
| Professional | | $121.17 | $260.25 | $406.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.21 / $58.44 / $113.86
| Professional | 26 | $29.21 | $58.44 | $113.86 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $151.72 / $151.72 / $153.33
| Professional | 52 | $151.72 | $151.72 | $153.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $83.27 / $180.86 / $321.52
| Professional | TC | $83.27 | $180.86 | $321.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.64 / $463.64 / $463.64
| Professional | | $463.64 | $463.64 | $463.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $139.62 / $139.62 / $139.62
| Professional | 26 | $139.62 | $139.62 | $139.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $324.02 / $324.02 / $324.02
| Professional | TC | $324.02 | $324.02 | $324.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.13 / $187.19 / $508.97
| Professional | | $136.13 | $187.19 | $508.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.25 / $193.31 / $397.84
| Professional | | $120.25 | $193.31 | $397.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.43 / $49.33 / $108.17
| Professional | 26 | $37.43 | $49.33 | $108.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $82.82 / $149.33 / $301.24
| Professional | TC | $82.82 | $149.33 | $301.24 |