- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $95.47 / $115.35 / $191.89
| Facility | 26 | $95.47 | $115.35 | $191.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.54 / $416.11 / $1,691.00
| Professional | | $329.54 | $416.11 | $1,691.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $84.58 / $104.86 / $275.55
| Professional | 26 | $84.58 | $104.86 | $275.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $240.52 / $307.36 / $682.33
| Professional | TC | $240.52 | $307.36 | $682.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.29 / $254.45 / $292.85
| Professional | | $223.29 | $254.45 | $292.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.31 / $97.84 / $164.82
| Professional | 26 | $73.31 | $97.84 | $164.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $176.55 / $220.22 / $368.60
| Professional | TC | $176.55 | $220.22 | $368.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.35 / $509.59 / $4,583.54
| Professional | | $385.35 | $509.59 | $4,583.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $110.21 / $128.19 / $1,416.95
| Professional | 26 | $110.21 | $128.19 | $1,416.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.88 / $540.77 / $870.62
| Professional | | $350.88 | $540.77 | $870.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.35 / $153.88 / $204.13
| Professional | 26 | $100.35 | $153.88 | $204.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $250.53 / $386.73 / $666.49
| Professional | TC | $250.53 | $386.73 | $666.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $108.46 / $108.46 / $108.46
| Facility | 26 | $108.46 | $108.46 | $108.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.44 / $493.30 / $787.18
| Professional | | $295.44 | $493.30 | $787.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.90 / $116.30 / $192.43
| Professional | 26 | $69.90 | $116.30 | $192.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $213.01 / $375.83 / $595.82
| Professional | TC | $213.01 | $375.83 | $595.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.40 / $532.98 / $818.75
| Professional | | $401.40 | $532.98 | $818.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $103.99 / $129.76 / $196.88
| Professional | 26 | $103.99 | $129.76 | $196.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $283.73 / $353.34 / $503.34
| Professional | TC | $283.73 | $353.34 | $503.34 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $712.82 / $712.82 / $712.82
| Facility | 26 | $712.82 | $712.82 | $712.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.61 / $418.07 / $547.79
| Professional | | $371.61 | $418.07 | $547.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $105.40 / $113.31 / $153.22
| Professional | 26 | $105.40 | $113.31 | $153.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $357.01 / $445.44 / $453.11
| Professional | TC | $357.01 | $445.44 | $453.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.12 / $483.50 / $4,583.54
| Professional | | $349.12 | $483.50 | $4,583.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $99.81 / $118.05 / $229.37
| Professional | 26 | $99.81 | $118.05 | $229.37 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $90.93 / $130.03 / $311.43
| Facility | 26 | $90.93 | $130.03 | $311.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.62 / $444.87 / $1,618.00
| Professional | | $336.62 | $444.87 | $1,618.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $89.59 / $120.06 / $257.60
| Professional | 26 | $89.59 | $120.06 | $257.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $245.69 / $331.91 / $865.21
| Professional | TC | $245.69 | $331.91 | $865.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.82 / $325.00 / $566.84
| Professional | | $106.82 | $325.00 | $566.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $108.46 / $108.46 / $108.46
| Facility | 26 | $108.46 | $108.46 | $108.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.00 / $488.65 / $787.18
| Professional | | $300.00 | $488.65 | $787.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.90 / $115.82 / $193.54
| Professional | 26 | $69.90 | $115.82 | $193.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $214.58 / $361.92 / $587.17
| Professional | TC | $214.58 | $361.92 | $587.17 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $93.95 / $93.95 / $99.96
| Facility | 26 | $93.95 | $93.95 | $99.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.06 / $341.49 / $517.86
| Professional | | $336.06 | $341.49 | $517.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $91.57 / $93.97 / $99.96
| Professional | 26 | $91.57 | $93.97 | $99.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $242.09 / $247.54 / $417.90
| Professional | TC | $242.09 | $247.54 | $417.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.19 / $414.85 / $670.41
| Professional | | $319.19 | $414.85 | $670.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $90.61 / $112.25 / $188.54
| Professional | 26 | $90.61 | $112.25 | $188.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $228.58 / $304.77 / $506.18
| Professional | TC | $228.58 | $304.77 | $506.18 |