- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $122.47 / $734.46 / $1,117.00
| Facility | | $122.47 | $734.46 | $1,117.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.39 / $21.62 / $25.98
| Facility | 26 | $16.39 | $21.62 | $25.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.18 / $127.87 / $194.76
| Professional | | $104.18 | $127.87 | $194.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.78 / $22.32 / $32.74
| Professional | 26 | $11.78 | $22.32 | $32.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $87.05 / $106.76 / $163.27
| Professional | TC | $87.05 | $106.76 | $163.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.00 / $119.00 / $148.86
| Professional | | $112.00 | $119.00 | $148.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.32 / $21.65 / $51.96
| Professional | 26 | $17.32 | $21.65 | $51.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.50 / $148.80 / $396.03
| Facility | | $134.50 | $148.80 | $396.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.02 / $91.32 / $175.06
| Professional | | $20.02 | $91.32 | $175.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.49 / $208.29 / $322.39
| Professional | | $113.49 | $208.29 | $322.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.18 / $135.18 / $138.62
| Facility | | $135.18 | $135.18 | $138.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.07 / $32.88 / $32.88
| Professional | 26 | $22.07 | $32.88 | $32.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.41 / $374.98 / $577.04
| Facility | | $138.41 | $374.98 | $577.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.75 / $26.75 / $26.75
| Facility | 26 | $26.75 | $26.75 | $26.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.19 / $200.16 / $338.53
| Professional | | $140.19 | $200.16 | $338.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.75 / $24.65 / $41.87
| Professional | 26 | $14.75 | $24.65 | $41.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $118.85 / $175.26 / $318.30
| Professional | TC | $118.85 | $175.26 | $318.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.79 / $601.01 / $708.89
| Facility | | $263.79 | $601.01 | $708.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $52.72 / $102.96 / $107.64
| Facility | 26 | $52.72 | $102.96 | $107.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.59 / $1,197.25 / $1,230.05
| Professional | | $1,122.59 | $1,197.25 | $1,230.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $198.13 / $198.13 / $198.13
| Professional | 26 | $198.13 | $198.13 | $198.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $934.20 / $1,126.14 / $1,157.00
| Professional | TC | $934.20 | $1,126.14 | $1,157.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.94 / $160.79 / $288.72
| Facility | | $118.94 | $160.79 | $288.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.22 / $200.46 / $311.45
| Professional | | $130.22 | $200.46 | $311.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.20 / $31.90 / $53.31
| Professional | 26 | $24.20 | $31.90 | $53.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $136.15 / $177.59 / $284.77
| Professional | TC | $136.15 | $177.59 | $284.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.96 / $140.60 / $435.60
| Professional | | $21.96 | $140.60 | $435.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.72 / $162.86 / $310.23
| Facility | | $119.72 | $162.86 | $310.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.75 / $26.75 / $26.75
| Facility | 26 | $26.75 | $26.75 | $26.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.16 / $223.74 / $390.72
| Professional | | $145.16 | $223.74 | $390.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.75 / $24.81 / $40.54
| Professional | 26 | $14.75 | $24.81 | $40.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $119.14 / $175.82 / $318.85
| Professional | TC | $119.14 | $175.82 | $318.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.74 / $175.23 / $278.12
| Professional | | $126.74 | $175.23 | $278.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.38 / $23.06 / $37.28
| Professional | 26 | $12.38 | $23.06 | $37.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $106.24 / $152.91 / $254.86
| Professional | TC | $106.24 | $152.91 | $254.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.60 / $128.06 / $174.10
| Professional | | $109.60 | $128.06 | $174.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.34 / $21.94 / $30.31
| Professional | 26 | $18.34 | $21.94 | $30.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $90.83 / $106.11 / $144.50
| Professional | TC | $90.83 | $106.11 | $144.50 |