- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $121.75 / $127.83 / $222.80
| Facility | 26 | $121.75 | $127.83 | $222.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $568.95 / $720.28 / $1,309.27
| Professional | | $568.95 | $720.28 | $1,309.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $112.06 / $144.08 / $494.45
| Professional | 26 | $112.06 | $144.08 | $494.45 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $274.11 / $304.37 / $436.24
| Professional | 52 | $274.11 | $304.37 | $436.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $451.82 / $557.16 / $913.09
| Professional | TC | $451.82 | $557.16 | $913.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.78 / $538.78 / $607.23
| Professional | | $538.78 | $538.78 | $607.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $113.25 / $178.97 / $219.90
| Professional | 26 | $113.25 | $178.97 | $219.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $121.49 / $121.49 / $145.57
| Professional | 26 | $121.49 | $121.49 | $145.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.29 / $929.11 / $1,741.97
| Professional | | $638.29 | $929.11 | $1,741.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $123.14 / $188.84 / $412.58
| Professional | 26 | $123.14 | $188.84 | $412.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $515.16 / $739.46 / $1,329.35
| Professional | TC | $515.16 | $739.46 | $1,329.35 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $133.97 / $133.97 / $133.97
| Facility | 26 | $133.97 | $133.97 | $133.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.71 / $838.66 / $1,388.15
| Professional | | $583.71 | $838.66 | $1,388.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $112.46 / $172.29 / $282.99
| Professional | 26 | $112.46 | $172.29 | $282.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $459.96 / $675.79 / $1,129.35
| Professional | TC | $459.96 | $675.79 | $1,129.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $652.26 / $951.84 / $1,258.27
| Professional | | $652.26 | $951.84 | $1,258.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $130.18 / $167.76 / $238.87
| Professional | 26 | $130.18 | $167.76 | $238.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $539.20 / $784.49 / $1,019.40
| Professional | TC | $539.20 | $784.49 | $1,019.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.93 / $658.31 / $854.40
| Professional | | $136.93 | $658.31 | $854.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $129.08 / $161.63 / $201.47
| Professional | 26 | $129.08 | $161.63 | $201.47 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $127.00 / $127.00 / $127.00
| Professional | 52 | $127.00 | $127.00 | $127.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $532.65 / $567.29 / $571.22
| Professional | TC | $532.65 | $567.29 | $571.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $121.49 / $121.49 / $247.80
| Professional | 26 | $121.49 | $121.49 | $247.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $121.75 / $166.02 / $246.01
| Facility | 26 | $121.75 | $166.02 | $246.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.52 / $770.15 / $1,755.07
| Professional | | $606.52 | $770.15 | $1,755.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $116.67 / $176.06 / $473.68
| Professional | 26 | $116.67 | $176.06 | $473.68 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $273.83 / $306.30 / $606.03
| Professional | 52 | $273.83 | $306.30 | $606.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $484.77 / $645.35 / $1,673.75
| Professional | TC | $484.77 | $645.35 | $1,673.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.08 / $810.50 / $1,224.39
| Professional | | $125.08 | $810.50 | $1,224.39 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $133.97 / $133.97 / $133.97
| Facility | 26 | $133.97 | $133.97 | $133.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.71 / $838.66 / $1,400.91
| Professional | | $583.71 | $838.66 | $1,400.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $112.23 / $167.81 / $288.64
| Professional | 26 | $112.23 | $167.81 | $288.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $462.27 / $675.79 / $1,138.08
| Professional | TC | $462.27 | $675.79 | $1,138.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $115.29 / $115.29 / $199.50
| Facility | 26 | $115.29 | $115.29 | $199.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $569.61 / $579.29 / $630.26
| Professional | | $569.61 | $579.29 | $630.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $112.49 / $115.29 / $119.39
| Professional | 26 | $112.49 | $115.29 | $119.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $454.40 / $464.01 / $510.87
| Professional | TC | $454.40 | $464.01 | $510.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $568.32 / $718.02 / $1,157.65
| Professional | | $568.32 | $718.02 | $1,157.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $109.35 / $151.32 / $243.62
| Professional | 26 | $109.35 | $151.32 | $243.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $442.13 / $594.40 / $969.34
| Professional | TC | $442.13 | $594.40 | $969.34 |