- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $74.13 / $112.20 / $173.78
| Facility | 26 | $74.13 | $112.20 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $398.11 / $1,412.54
| Professional | | $100.00 | $398.11 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.57 / $131.83 / $380.19
| Professional | 26 | $64.57 | $131.83 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $138.04 / $371.54 / $1,778.28
| Professional | 50 | $138.04 | $371.54 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $100.00 / $288.40 / $1,023.29
| Professional | 52 | $100.00 | $288.40 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $151.36 / $295.12 / $776.25
| Professional | TC | $151.36 | $295.12 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $165.96 / $338.84
| Professional | | $141.25 | $165.96 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.48 / $58.88 / $117.49
| Professional | 26 | $35.48 | $58.88 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $218.78 / $218.78 / $218.78
| Professional | 50 | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $223.87 / $223.87 / $223.87
| Professional | TC | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $263.03 / $776.25
| Professional | | $204.17 | $263.03 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.26 / $74.13 / $141.25
| Professional | 26 | $60.26 | $74.13 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $309.03 / $380.19 / $1,096.48
| Professional | 50 | $309.03 | $380.19 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $144.54 / $181.97 / $524.81
| Professional | TC | $144.54 | $181.97 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $218.78 / $316.23
| Professional | | $93.33 | $218.78 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $15.49 / $72.44 / $104.71
| Facility | 26 | $15.49 | $72.44 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $501.19 / $1,778.28
| Professional | | $208.93 | $501.19 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.12 / $102.33 / $239.88
| Professional | 26 | $50.12 | $102.33 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $141.25 / $371.54 / $1,548.82
| Professional | TC | $141.25 | $371.54 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $288.40 / $446.68
| Professional | | $223.87 | $288.40 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.10 / $93.33 / $223.87
| Professional | 26 | $63.10 | $93.33 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $151.36 / $199.53 / $295.12
| Professional | TC | $151.36 | $199.53 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $354.81 / $512.86
| Professional | | $190.55 | $354.81 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $102.33 / $147.91
| Professional | 26 | $52.48 | $102.33 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $131.83 / $251.19 / $354.81
| Professional | TC | $131.83 | $251.19 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $223.87 / $234.42
| Professional | | $223.87 | $223.87 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $89.13 / $89.13 / $91.20
| Professional | 26 | $89.13 | $89.13 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $275.42 / $489.78
| Professional | | $208.93 | $275.42 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $81.28 / $83.18 / $109.65
| Professional | 26 | $81.28 | $83.18 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $549.54 / $977.24 / $1,000.00
| Professional | 50 | $549.54 | $977.24 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $134.90 / $134.90 / $134.90
| Professional | 52 | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $199.53 / $199.53 / $199.53
| Professional | TC | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $549.54 / $724.44
| Professional | | $275.42 | $549.54 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $169.82 / $208.93
| Professional | 26 | $85.11 | $169.82 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $199.53 / $380.19 / $512.86
| Professional | TC | $199.53 | $380.19 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $263.03 / $691.83
| Professional | | $177.83 | $263.03 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $67.61 / $151.36
| Professional | 26 | $52.48 | $67.61 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $125.89 / $177.83 / $524.81
| Professional | TC | $125.89 | $177.83 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $75.86 / $218.78
| Facility | 26 | $52.48 | $75.86 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $338.84 / $602.56
| Professional | | $190.55 | $338.84 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $93.33 / $186.21
| Professional | 26 | $52.48 | $93.33 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $131.83 / $245.47 / $407.38
| Professional | TC | $131.83 | $245.47 | $407.38 |