- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $30.90 / $93.33
| Facility | | $23.99 | $30.90 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $14.45 / $20.89
| Facility | 26 | $14.45 | $14.45 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.33 / $9.33 / $14.45
| Facility | TC | $9.33 | $9.33 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $20.89 / $31.62
| Professional | | $12.88 | $20.89 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $13.80 / $33.11
| Professional | 26 | $7.59 | $13.80 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.25 / $8.91 / $12.59
| Professional | TC | $5.25 | $8.91 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $14.79 / $25.70
| Professional | | $10.96 | $14.79 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $22.91 / $32.36
| Professional | | $19.50 | $22.91 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $14.79 / $19.50
| Professional | 26 | $12.02 | $14.79 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.08 / $8.13 / $12.59
| Professional | TC | $7.08 | $8.13 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $25.12 / $36.31
| Facility | | $16.60 | $25.12 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $27.54 / $54.95
| Professional | | $19.95 | $27.54 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $15.85 / $19.50
| Professional | 26 | $12.02 | $15.85 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.41 / $8.71 / $12.59
| Professional | TC | $7.41 | $8.71 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $13.18 / $41.69
| Professional | | $10.47 | $13.18 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $7.76 / $24.55
| Professional | 26 | $6.92 | $7.76 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.80 / $5.37 / $16.98
| Professional | TC | $3.80 | $5.37 | $16.98 |