- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.20 / $787.06 / $1,169.18
| Facility | | $307.20 | $787.06 | $1,169.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.09 / $22.60 / $77.03
| Facility | 26 | $22.09 | $22.60 | $77.03 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $105.88 / $544.25 / $1,034.02
| Facility | TC | $105.88 | $544.25 | $1,034.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.44 / $156.09 / $750.41
| Professional | | $21.44 | $156.09 | $750.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.87 / $34.57 / $220.10
| Professional | 26 | $19.87 | $34.57 | $220.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $94.40 / $122.57 / $348.52
| Professional | TC | $94.40 | $122.57 | $348.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.55 / $206.80 / $710.20
| Professional | | $117.55 | $206.80 | $710.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.35 / $37.04 / $131.41
| Professional | 26 | $21.35 | $37.04 | $131.41 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $95.66 / $170.63 / $583.95
| Professional | TC | $95.66 | $170.63 | $583.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.65 / $106.00 / $153.10
| Facility | | $21.65 | $106.00 | $153.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.12 / $104.16 / $142.84
| Professional | | $21.12 | $104.16 | $142.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $325.30 / $380.14 / $583.15
| Facility | | $325.30 | $380.14 | $583.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $54.07 / $63.18 / $96.92
| Facility | 26 | $54.07 | $63.18 | $96.92 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $271.24 / $316.95 / $486.23
| Facility | TC | $271.24 | $316.95 | $486.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.76 / $301.36 / $342.45
| Professional | | $142.76 | $301.36 | $342.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.02 / $52.57 / $59.74
| Professional | 26 | $24.02 | $52.57 | $59.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $115.32 / $248.79 / $282.70
| Professional | TC | $115.32 | $248.79 | $282.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.03 / $154.84 / $307.20
| Facility | | $111.03 | $154.84 | $307.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.12 / $249.03 / $1,035.03
| Facility | | $120.12 | $249.03 | $1,035.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $107.00 / $107.00 / $417.57
| Facility | 26 | $107.00 | $107.00 | $417.57 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $376.27 / $678.78 / $1,110.01
| Facility | TC | $376.27 | $678.78 | $1,110.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.56 / $264.14 / $1,052.95
| Professional | | $151.56 | $264.14 | $1,052.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.38 / $57.58 / $237.75
| Professional | 26 | $26.38 | $57.58 | $237.75 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,378.00 / $1,378.00 / $1,378.00
| Professional | 50 | $1,378.00 | $1,378.00 | $1,378.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $123.28 / $220.32 / $927.48
| Professional | TC | $123.28 | $220.32 | $927.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.40 / $148.90 / $221.00
| Professional | | $58.40 | $148.90 | $221.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.88 / $154.84 / $307.20
| Facility | | $109.88 | $154.84 | $307.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.93 / $280.37 / $402.00
| Professional | | $220.93 | $280.37 | $402.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $283.33 / $535.91 / $535.91
| Facility | | $283.33 | $535.91 | $535.91 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $107.00 / $107.00
| Facility | 26 | $100.00 | $107.00 | $107.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $233.90 / $442.03 / $442.03
| Facility | TC | $233.90 | $442.03 | $442.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.99 / $588.70 / $1,052.95
| Professional | | $135.99 | $588.70 | $1,052.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.72 / $108.65 / $237.75
| Professional | 26 | $23.72 | $108.65 | $237.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $112.27 / $480.05 / $927.48
| Professional | TC | $112.27 | $480.05 | $927.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.92 / $608.67 / $608.67
| Professional | | $255.92 | $608.67 | $608.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.22 / $55.13 / $69.76
| Professional | 26 | $49.22 | $55.13 | $69.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $206.70 / $240.04 / $303.72
| Professional | TC | $206.70 | $240.04 | $303.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.72 / $231.28 / $441.53
| Professional | | $134.72 | $231.28 | $441.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.46 / $71.42 / $100.00
| Professional | 26 | $33.46 | $71.42 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $87.90 / $259.74 / $645.22
| Professional | TC | $87.90 | $259.74 | $645.22 |