- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.00 / $221.12 / $303.80
| Facility | | $200.00 | $221.12 | $303.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $118.50 / $164.00 / $164.00
| Facility | 26 | $118.50 | $164.00 | $164.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.65 / $221.12 / $535.54
| Professional | | $133.65 | $221.12 | $535.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.81 / $79.95 / $284.72
| Professional | 26 | $51.81 | $79.95 | $284.72 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $65.23 / $77.14 / $153.65
| Professional | 52 | $65.23 | $77.14 | $153.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $60.14 / $102.62 / $347.30
| Professional | TC | $60.14 | $102.62 | $347.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.66 / $339.46 / $920.94
| Professional | | $142.66 | $339.46 | $920.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $76.45 / $156.28 / $453.06
| Professional | 26 | $76.45 | $156.28 | $453.06 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $66.20 / $182.74 / $432.16
| Professional | TC | $66.20 | $182.74 | $432.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.56 / $100.39 / $186.48
| Facility | | $65.56 | $100.39 | $186.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.95 / $104.25 / $209.86
| Professional | | $71.95 | $104.25 | $209.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.59 / $462.28 / $614.41
| Facility | | $395.59 | $462.28 | $614.41 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $205.46 / $240.09 / $319.10
| Facility | 26 | $205.46 | $240.09 | $319.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.28 / $517.62 / $602.97
| Professional | | $209.28 | $517.62 | $602.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $68.40 / $276.45 / $314.14
| Professional | 26 | $68.40 | $276.45 | $314.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $96.29 / $241.16 / $376.80
| Professional | TC | $96.29 | $241.16 | $376.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.47 / $221.12 / $577.55
| Facility | | $130.47 | $221.12 | $577.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.47 / $221.12 / $692.87
| Facility | | $130.47 | $221.12 | $692.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $366.35 / $366.35 / $366.35
| Facility | 26 | $366.35 | $366.35 | $366.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.91 / $490.07 / $3,102.49
| Professional | | $187.91 | $490.07 | $3,102.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $84.00 / $192.91 / $551.37
| Professional | 26 | $84.00 | $192.91 | $551.37 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $89.33 / $239.03 / $2,808.09
| Professional | TC | $89.33 | $239.03 | $2,808.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.72 / $118.13 / $278.05
| Professional | | $50.72 | $118.13 | $278.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.47 / $221.12 / $577.55
| Facility | | $130.47 | $221.12 | $577.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.60 / $432.37 / $869.77
| Professional | | $288.60 | $432.37 | $869.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $702.00 / $2,025.75 / $2,025.75
| Facility | | $702.00 | $2,025.75 | $2,025.75 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $187.80 / $366.35 / $366.35
| Facility | 26 | $187.80 | $366.35 | $366.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.13 / $1,689.52 / $3,102.49
| Professional | | $246.13 | $1,689.52 | $3,102.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $116.44 / $410.75 / $551.37
| Professional | 26 | $116.44 | $410.75 | $551.37 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $114.67 / $1,507.97 / $2,808.09
| Professional | TC | $114.67 | $1,507.97 | $2,808.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.32 / $922.30 / $922.30
| Professional | | $347.32 | $922.30 | $922.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $91.04 / $120.85 / $374.21
| Professional | 26 | $91.04 | $120.85 | $374.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $181.18 / $226.47 / $711.19
| Professional | TC | $181.18 | $226.47 | $711.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.43 / $371.58 / $904.05
| Professional | | $176.43 | $371.58 | $904.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $82.24 / $161.13 / $360.03
| Professional | 26 | $82.24 | $161.13 | $360.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $81.84 / $200.98 / $535.04
| Professional | TC | $81.84 | $200.98 | $535.04 |