- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $122.75 / $192.71 / $352.39
| Facility | 26 | $122.75 | $192.71 | $352.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.52 / $522.50 / $1,042.61
| Professional | | $360.52 | $522.50 | $1,042.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $108.94 / $156.35 / $395.29
| Professional | 26 | $108.94 | $156.35 | $395.29 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $174.43 / $213.36 / $507.18
| Professional | 52 | $174.43 | $213.36 | $507.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $269.19 / $347.55 / $687.85
| Professional | TC | $269.19 | $347.55 | $687.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.74 / $603.97 / $944.66
| Professional | | $303.74 | $603.97 | $944.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $86.39 / $186.78 / $211.10
| Professional | 26 | $86.39 | $186.78 | $211.10 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $603.97 / $603.97 / $603.97
| Professional | 52 | $603.97 | $603.97 | $603.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $157.79 / $402.23 / $471.69
| Professional | TC | $157.79 | $402.23 | $471.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $1,013.76 / $1,013.76 / $1,013.76
| Facility | 26 | $1,013.76 | $1,013.76 | $1,013.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.46 / $790.13 / $6,146.58
| Professional | | $462.46 | $790.13 | $6,146.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $148.76 / $259.85 / $921.60
| Professional | 26 | $148.76 | $259.85 | $921.60 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $61.81 / $61.81 / $320.58
| Professional | 52 | $61.81 | $61.81 | $320.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $313.70 / $564.01 / $5,551.18
| Professional | TC | $313.70 | $564.01 | $5,551.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.62 / $707.11 / $1,330.97
| Professional | | $351.62 | $707.11 | $1,330.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $107.66 / $198.24 / $341.01
| Professional | 26 | $107.66 | $198.24 | $341.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $242.94 / $487.28 / $1,008.01
| Professional | TC | $242.94 | $487.28 | $1,008.01 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $119.66 / $245.61 / $1,102.78
| Facility | 26 | $119.66 | $245.61 | $1,102.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.92 / $825.75 / $1,814.06
| Professional | | $457.92 | $825.75 | $1,814.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $106.69 / $231.56 / $298.12
| Professional | 26 | $106.69 | $231.56 | $298.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $319.99 / $601.91 / $1,551.82
| Professional | TC | $319.99 | $601.91 | $1,551.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.59 / $274.36 / $658.21
| Professional | | $57.59 | $274.36 | $658.21 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $176.55 / $213.20 / $219.09
| Facility | 26 | $176.55 | $213.20 | $219.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.17 / $298.17 / $298.17
| Professional | | $298.17 | $298.17 | $298.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $131.05 / $196.20 / $238.71
| Professional | 26 | $131.05 | $196.20 | $238.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $298.39 / $495.13 / $897.50
| Professional | TC | $298.39 | $495.13 | $897.50 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $145.87 / $145.87 / $146.69
| Facility | 26 | $145.87 | $145.87 | $146.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.44 / $773.23 / $972.50
| Professional | | $513.44 | $773.23 | $972.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $167.02 / $252.43 / $305.58
| Professional | 26 | $167.02 | $252.43 | $305.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $346.42 / $520.47 / $664.44
| Professional | TC | $346.42 | $520.47 | $664.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $714.15 / $714.15 / $1,538.06
| Facility | 26 | $714.15 | $714.15 | $1,538.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.46 / $679.54 / $985.00
| Professional | | $462.46 | $679.54 | $985.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $148.76 / $222.13 / $298.89
| Professional | 26 | $148.76 | $222.13 | $298.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $313.70 / $457.41 / $686.10
| Professional | TC | $313.70 | $457.41 | $686.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.04 / $628.09 / $1,143.94
| Professional | | $315.04 | $628.09 | $1,143.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $99.70 / $128.22 / $316.57
| Professional | 26 | $99.70 | $128.22 | $316.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $215.34 / $433.84 / $817.18
| Professional | TC | $215.34 | $433.84 | $817.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.17 / $368.17 / $368.17
| Professional | | $368.17 | $368.17 | $368.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $113.20 / $113.20 / $113.20
| Professional | 26 | $113.20 | $113.20 | $113.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $254.97 / $254.97 / $254.97
| Professional | TC | $254.97 | $254.97 | $254.97 |