- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $72.68 / $109.02 / $208.98
| Facility | 26 | $72.68 | $109.02 | $208.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.36 / $475.00 / $1,006.86
| Professional | | $221.36 | $475.00 | $1,006.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.68 / $140.00 / $306.00
| Professional | 26 | $72.68 | $140.00 | $306.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $475.00 / $813.03 / $1,084.04
| Professional | 50 | $475.00 | $813.03 | $1,084.04 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $125.00 / $187.50 / $319.91
| Professional | 52 | $125.00 | $187.50 | $319.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $175.97 / $335.00 / $502.50
| Professional | TC | $175.97 | $335.00 | $502.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.58 / $385.41 / $594.78
| Professional | | $282.58 | $385.41 | $594.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.60 / $107.09 / $123.82
| Professional | 26 | $50.60 | $107.09 | $123.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $265.94 / $265.94 / $311.80
| Professional | TC | $265.94 | $265.94 | $311.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $603.28 / $603.28 / $603.28
| Facility | 26 | $603.28 | $603.28 | $603.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.45 / $524.36 / $2,791.06
| Professional | | $292.45 | $524.36 | $2,791.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $89.17 / $157.91 / $530.54
| Professional | 26 | $89.17 | $157.91 | $530.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $363.20 / $528.61 / $1,139.16
| Professional | 50 | $363.20 | $528.61 | $1,139.16 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $36.53 / $36.53 / $206.44
| Professional | 52 | $36.53 | $36.53 | $206.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $203.28 / $368.45 / $2,451.15
| Professional | TC | $203.28 | $368.45 | $2,451.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.19 / $448.35 / $781.78
| Professional | | $224.19 | $448.35 | $781.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.76 / $117.09 / $202.98
| Professional | 26 | $63.76 | $117.09 | $202.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $159.07 / $325.41 / $672.66
| Professional | TC | $159.07 | $325.41 | $672.66 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $71.43 / $145.38 / $698.97
| Facility | 26 | $71.43 | $145.38 | $698.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.16 / $518.87 / $1,161.67
| Professional | | $259.16 | $518.87 | $1,161.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $63.55 / $136.61 / $176.64
| Professional | 26 | $63.55 | $136.61 | $176.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $198.71 / $371.62 / $1,012.16
| Professional | TC | $198.71 | $371.62 | $1,012.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.29 / $183.24 / $439.80
| Professional | | $38.29 | $183.24 | $439.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $104.98 / $126.07 / $129.97
| Facility | 26 | $104.98 | $126.07 | $129.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.34 / $160.34 / $178.16
| Professional | | $160.34 | $160.34 | $178.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.18 / $116.58 / $147.16
| Professional | 26 | $77.18 | $116.58 | $147.16 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $199.01 / $308.57 / $633.50
| Professional | TC | $199.01 | $308.57 | $633.50 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $87.29 / $87.29 / $87.43
| Facility | 26 | $87.29 | $87.29 | $87.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.27 / $492.13 / $612.14
| Professional | | $325.27 | $492.13 | $612.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $98.63 / $149.91 / $181.83
| Professional | 26 | $98.63 | $149.91 | $181.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $226.30 / $341.73 / $431.66
| Professional | TC | $226.30 | $341.73 | $431.66 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $446.45 / $446.45 / $782.93
| Facility | 26 | $446.45 | $446.45 | $782.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.45 / $432.50 / $618.96
| Professional | | $292.45 | $432.50 | $618.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $89.17 / $132.16 / $178.42
| Professional | 26 | $89.17 | $132.16 | $178.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $203.28 / $302.72 / $440.54
| Professional | TC | $203.28 | $302.72 | $440.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.56 / $406.74 / $665.08
| Professional | | $197.56 | $406.74 | $665.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.90 / $76.30 / $189.12
| Professional | 26 | $58.90 | $76.30 | $189.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $138.66 / $285.48 / $504.22
| Professional | TC | $138.66 | $285.48 | $504.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.48 / $235.48 / $235.48
| Professional | | $235.48 | $235.48 | $235.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $66.93 / $66.93 / $66.93
| Professional | 26 | $66.93 | $66.93 | $66.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $168.54 / $168.54 / $168.54
| Professional | TC | $168.54 | $168.54 | $168.54 |