- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $56.28 / $58.41 / $115.65
| Facility | 26 | $56.28 | $58.41 | $115.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.44 / $302.12 / $1,124.00
| Professional | | $244.44 | $302.12 | $1,124.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.49 / $95.20 / $361.65
| Professional | 26 | $52.49 | $95.20 | $361.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $162.34 / $199.91 / $357.62
| Professional | TC | $162.34 | $199.91 | $357.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.24 / $200.20 / $437.93
| Professional | | $169.24 | $200.20 | $437.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.50 / $54.67 / $89.78
| Professional | 26 | $40.50 | $54.67 | $89.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $151.36 / $151.36 / $305.95
| Professional | TC | $151.36 | $151.36 | $305.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.41 / $318.64 / $735.43
| Professional | | $291.41 | $318.64 | $735.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.11 / $68.53 / $404.14
| Professional | 26 | $57.11 | $68.53 | $404.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.52 / $308.00 / $520.00
| Professional | | $298.52 | $308.00 | $520.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.65 / $89.09 / $181.93
| Professional | 26 | $64.65 | $89.09 | $181.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $233.87 / $328.27 / $506.31
| Professional | TC | $233.87 | $328.27 | $506.31 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $62.58 / $62.58 / $62.58
| Facility | 26 | $62.58 | $62.58 | $62.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.76 / $402.00 / $628.17
| Professional | | $248.76 | $402.00 | $628.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.31 / $93.00 / $151.86
| Professional | 26 | $51.31 | $93.00 | $151.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $200.62 / $311.14 / $481.29
| Professional | TC | $200.62 | $311.14 | $481.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.48 / $407.35 / $824.33
| Professional | | $323.48 | $407.35 | $824.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $65.37 / $80.78 / $163.47
| Professional | 26 | $65.37 | $80.78 | $163.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $258.12 / $326.57 / $660.86
| Professional | TC | $258.12 | $326.57 | $660.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $153.77 / $153.77 / $153.77
| Facility | 26 | $153.77 | $153.77 | $153.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.45 / $326.76 / $382.62
| Professional | | $297.45 | $326.76 | $382.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $60.77 / $71.97 / $104.04
| Professional | 26 | $60.77 | $71.97 | $104.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $366.79 / $369.24 / $369.24
| Professional | TC | $366.79 | $369.24 | $369.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.41 / $297.26 / $735.43
| Professional | | $265.41 | $297.26 | $735.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.41 / $60.94 / $166.05
| Professional | 26 | $54.41 | $60.94 | $166.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $53.60 / $72.36 / $181.66
| Facility | 26 | $53.60 | $72.36 | $181.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.06 / $362.71 / $1,012.50
| Professional | | $249.06 | $362.71 | $1,012.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.93 / $96.05 / $290.56
| Professional | 26 | $52.93 | $96.05 | $290.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $169.77 / $240.86 / $481.55
| Professional | TC | $169.77 | $240.86 | $481.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.53 / $340.90 / $685.90
| Professional | | $80.53 | $340.90 | $685.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $62.58 / $62.58 / $62.58
| Facility | 26 | $62.58 | $62.58 | $62.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.74 / $393.54 / $628.17
| Professional | | $248.74 | $393.54 | $628.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $51.31 / $90.55 / $156.21
| Professional | 26 | $51.31 | $90.55 | $156.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $200.62 / $309.58 / $489.26
| Professional | TC | $200.62 | $309.58 | $489.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $54.39 / $54.39 / $93.00
| Facility | 26 | $54.39 | $54.39 | $93.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.80 / $254.81 / $358.00
| Professional | | $250.80 | $254.81 | $358.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.76 / $54.66 / $93.00
| Professional | 26 | $52.76 | $54.66 | $93.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $196.14 / $200.41 / $265.00
| Professional | TC | $196.14 | $200.41 | $265.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.50 / $333.77 / $554.65
| Professional | | $253.50 | $333.77 | $554.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.67 / $76.91 / $122.06
| Professional | 26 | $52.67 | $76.91 | $122.06 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $199.20 / $266.31 / $436.99
| Professional | TC | $199.20 | $266.31 | $436.99 |