- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $114.73 / $154.85 / $374.22
| Facility | 26 | $114.73 | $154.85 | $374.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.60 / $460.60 / $1,972.45
| Professional | | $329.60 | $460.60 | $1,972.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $108.70 / $175.13 / $498.26
| Professional | 26 | $108.70 | $175.13 | $498.26 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $163.31 / $201.04 / $237.50
| Professional | 52 | $163.31 | $201.04 | $237.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $217.91 / $299.00 / $783.89
| Professional | TC | $217.91 | $299.00 | $783.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.35 / $249.35 / $305.48
| Professional | | $169.35 | $249.35 | $305.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $82.06 / $111.64 / $179.40
| Professional | 26 | $82.06 | $111.64 | $179.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $126.23 / $190.98 / $319.70
| Professional | TC | $126.23 | $190.98 | $319.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.76 / $484.88 / $2,862.80
| Professional | | $364.76 | $484.88 | $2,862.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $126.14 / $146.88 / $1,568.03
| Professional | 26 | $126.14 | $146.88 | $1,568.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.35 / $562.54 / $1,788.31
| Professional | | $406.35 | $562.54 | $1,788.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $139.47 / $176.14 / $275.20
| Professional | 26 | $139.47 | $176.14 | $275.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $269.79 / $381.42 / $1,578.86
| Professional | TC | $269.79 | $381.42 | $1,578.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $123.88 / $123.88 / $123.88
| Facility | 26 | $123.88 | $123.88 | $123.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.95 / $647.37 / $1,391.92
| Professional | | $282.95 | $647.37 | $1,391.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $78.52 / $135.25 / $215.67
| Professional | 26 | $78.52 | $135.25 | $215.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $194.00 / $470.06 / $1,175.91
| Professional | TC | $194.00 | $470.06 | $1,175.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.16 / $501.77 / $2,221.21
| Professional | | $378.16 | $501.77 | $2,221.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $119.16 / $142.80 / $225.10
| Professional | 26 | $119.16 | $142.80 | $225.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $246.10 / $306.43 / $436.48
| Professional | TC | $246.10 | $306.43 | $436.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.22 / $383.05 / $664.69
| Professional | | $348.22 | $383.05 | $664.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $120.41 / $135.38 / $202.10
| Professional | 26 | $120.41 | $135.38 | $202.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $315.66 / $383.37 / $386.79
| Professional | TC | $315.66 | $383.37 | $386.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.38 / $460.05 / $2,009.87
| Professional | | $359.38 | $460.05 | $2,009.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $121.78 / $146.88 / $1,568.03
| Professional | 26 | $121.78 | $146.88 | $1,568.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $109.27 / $156.26 / $412.02
| Facility | 26 | $109.27 | $156.26 | $412.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.85 / $475.00 / $1,630.00
| Professional | | $329.85 | $475.00 | $1,630.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $107.53 / $161.00 / $374.22
| Professional | 26 | $107.53 | $161.00 | $374.22 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $164.80 / $212.50 / $435.30
| Professional | 52 | $164.80 | $212.50 | $435.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $220.57 / $304.38 / $827.00
| Professional | TC | $220.57 | $304.38 | $827.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.10 / $328.75 / $700.00
| Professional | | $126.10 | $328.75 | $700.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $77.68 / $123.88 / $123.88
| Facility | 26 | $77.68 | $123.88 | $123.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.05 / $640.25 / $1,319.26
| Professional | | $301.05 | $640.25 | $1,319.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.84 / $133.87 / $221.45
| Professional | 26 | $81.84 | $133.87 | $221.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $198.98 / $451.04 / $1,132.36
| Professional | TC | $198.98 | $451.04 | $1,132.36 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $107.53 / $107.53 / $122.00
| Facility | 26 | $107.53 | $107.53 | $122.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.45 / $319.95 / $1,040.00
| Professional | | $315.45 | $319.95 | $1,040.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $104.78 / $107.58 / $122.00
| Professional | 26 | $104.78 | $107.58 | $122.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $207.89 / $212.43 / $918.00
| Professional | TC | $207.89 | $212.43 | $918.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.33 / $476.01 / $1,048.15
| Professional | | $317.33 | $476.01 | $1,048.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $102.51 / $126.72 / $212.55
| Professional | 26 | $102.51 | $126.72 | $212.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $213.66 / $308.62 / $852.16
| Professional | TC | $213.66 | $308.62 | $852.16 |