- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $30.90 / $46.77
| Professional | | $23.99 | $30.90 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $15.14 / $19.95
| Professional | 26 | $10.96 | $15.14 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.02 / $15.85 / $25.12
| Professional | TC | $12.02 | $15.85 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $57.54
| Professional | | $30.90 | $30.90 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $47.86 / $81.28
| Professional | | $20.89 | $47.86 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $19.50 / $35.48
| Professional | 26 | $9.33 | $19.50 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.48 / $26.30 / $42.66
| Professional | TC | $11.48 | $26.30 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $41.69 / $52.48
| Professional | | $34.67 | $41.69 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $18.62 / $23.44
| Professional | 26 | $15.49 | $18.62 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $22.91 / $28.84
| Professional | TC | $19.05 | $22.91 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $128.82
| Facility | | $117.49 | $117.49 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $33.11 / $79.43
| Professional | | $21.38 | $33.11 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $16.60 / $33.11
| Professional | 26 | $13.18 | $16.60 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $19.05 / $50.12
| Professional | TC | $15.14 | $19.05 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $27.54 / $51.29
| Professional | | $19.05 | $27.54 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $11.75 / $22.91
| Professional | 26 | $8.51 | $11.75 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.23 / $14.79 / $28.84
| Professional | TC | $10.23 | $14.79 | $28.84 |