- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $177.83 / $199.53 / $229.09
| Facility | 26 | $177.83 | $199.53 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $501.19 / $1,318.26
| Professional | | $346.74 | $501.19 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $141.25 / $316.23
| Professional | 26 | $85.11 | $141.25 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $257.04 / $338.84 / $660.69
| Professional | TC | $257.04 | $338.84 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $537.03 / $1,949.84
| Professional | | $338.84 | $537.03 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $83.18 / $128.82 / $478.63
| Professional | 26 | $83.18 | $128.82 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $251.19 / $436.52 / $1,513.56
| Professional | TC | $251.19 | $436.52 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $223.87 / $263.03 / $416.87
| Facility | 26 | $223.87 | $263.03 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $812.83 / $1,412.54
| Professional | | $363.08 | $812.83 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.62 / $186.21 / $346.74
| Professional | 26 | $77.62 | $186.21 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $275.42 / $602.56 / $1,047.13
| Professional | TC | $275.42 | $602.56 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $741.31 / $1,023.29
| Professional | | $616.60 | $741.31 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $154.88 / $186.21 / $251.19
| Professional | 26 | $154.88 | $186.21 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $467.74 / $562.34 / $776.25
| Professional | TC | $467.74 | $562.34 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Facility | 26 | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $851.14 / $3,019.95
| Professional | | $446.68 | $851.14 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $91.20 / $177.83 / $851.14
| Professional | 26 | $91.20 | $177.83 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $338.84 / $660.69 / $2,570.40
| Professional | TC | $338.84 | $660.69 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $691.83
| Professional | | $32.36 | $33.11 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $851.14 / $1,513.56
| Professional | | $436.52 | $851.14 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $199.53 / $776.25 / $776.25
| Facility | 26 | $199.53 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $1,862.09 / $3,019.95
| Professional | | $489.78 | $1,862.09 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $104.71 / $436.52 / $851.14
| Professional | 26 | $104.71 | $436.52 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $371.54 / $1,548.82 / $2,630.27
| Professional | TC | $371.54 | $1,548.82 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,137.96 / $2,951.21
| Professional | | $1,778.28 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $331.13 / $512.86 / $660.69
| Professional | 26 | $331.13 | $512.86 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $1,318.26 / $1,819.70 / $2,238.72
| Professional | TC | $1,318.26 | $1,819.70 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $645.65 / $1,380.38
| Professional | | $389.05 | $645.65 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $89.13 / $138.04 / $323.59
| Professional | 26 | $89.13 | $138.04 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $295.12 / $501.19 / $1,071.52
| Professional | TC | $295.12 | $501.19 | $1,071.52 |