- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $137.41 / $144.66 / $905.22
| Facility | 26 | $137.41 | $144.66 | $905.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.47 / $412.71 / $1,351.82
| Professional | | $317.47 | $412.71 | $1,351.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $131.81 / $144.66 / $429.60
| Professional | 26 | $131.81 | $144.66 | $429.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $185.65 / $228.89 / $583.47
| Professional | TC | $185.65 | $228.89 | $583.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.04 / $603.74 / $1,209.77
| Professional | | $468.04 | $603.74 | $1,209.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $184.90 / $231.12 / $465.81
| Professional | 26 | $184.90 | $231.12 | $465.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $283.12 / $365.22 / $734.85
| Professional | TC | $283.12 | $365.22 | $734.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.35 / $405.46 / $988.84
| Professional | | $275.35 | $405.46 | $988.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $111.50 / $160.33 / $395.04
| Professional | 26 | $111.50 | $160.33 | $395.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $163.84 / $245.14 / $588.40
| Professional | TC | $163.84 | $245.14 | $588.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.60 / $481.52 / $1,221.38
| Professional | | $340.60 | $481.52 | $1,221.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $129.34 / $190.93 / $437.32
| Professional | 26 | $129.34 | $190.93 | $437.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $208.11 / $304.85 / $837.32
| Professional | TC | $208.11 | $304.85 | $837.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.39 / $601.26 / $811.70
| Professional | | $313.39 | $601.26 | $811.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $125.36 / $176.45 / $238.21
| Professional | 26 | $125.36 | $176.45 | $238.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $188.03 / $424.81 / $573.49
| Professional | TC | $188.03 | $424.81 | $573.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.51 / $601.26 / $1,063.39
| Professional | | $454.51 | $601.26 | $1,063.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $151.55 / $218.24 / $364.39
| Professional | 26 | $151.55 | $218.24 | $364.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $327.77 / $498.51 / $798.64
| Professional | TC | $327.77 | $498.51 | $798.64 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $357.19 / $767.93 / $767.93
| Facility | 26 | $357.19 | $767.93 | $767.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,872.34 / $2,872.34 / $3,891.45
| Professional | | $2,872.34 | $2,872.34 | $3,891.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $948.42 / $948.42 / $1,248.45
| Professional | 26 | $948.42 | $948.42 | $1,248.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $1,923.92 / $1,923.92 / $2,643.00
| Professional | TC | $1,923.92 | $1,923.92 | $2,643.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.89 / $502.45 / $1,169.58
| Professional | | $350.89 | $502.45 | $1,169.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $131.99 / $192.46 / $414.44
| Professional | 26 | $131.99 | $192.46 | $414.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $214.76 / $305.79 / $787.19
| Professional | TC | $214.76 | $305.79 | $787.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,365.78 / $1,365.78 / $1,365.78
| Professional | | $1,365.78 | $1,365.78 | $1,365.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $502.27 / $502.27 / $502.27
| Professional | 26 | $502.27 | $502.27 | $502.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $863.51 / $863.51 / $863.51
| Professional | TC | $863.51 | $863.51 | $863.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.41 / $508.25 / $668.59
| Professional | | $407.41 | $508.25 | $668.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.51 / $521.95 / $1,255.15
| Professional | | $280.51 | $521.95 | $1,255.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $119.65 / $196.24 / $438.31
| Professional | 26 | $119.65 | $196.24 | $438.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $160.86 / $325.70 / $789.80
| Professional | TC | $160.86 | $325.70 | $789.80 |