- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $33.11 / $51.29
| Professional | | $23.99 | $33.11 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $15.14 / $19.05
| Professional | 26 | $10.96 | $15.14 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.02 / $16.98 / $33.88
| Professional | TC | $12.02 | $16.98 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $31.62
| Professional | | $31.62 | $31.62 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $37.15 / $53.70
| Professional | | $29.51 | $37.15 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $17.38 / $23.99
| Professional | 26 | $12.88 | $17.38 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $22.39 / $31.62
| Professional | TC | $15.49 | $22.39 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $40.74 / $67.61
| Professional | | $26.30 | $40.74 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $16.98 / $23.99
| Professional | 26 | $12.59 | $16.98 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.49 / $27.54 / $43.65
| Professional | TC | $13.49 | $27.54 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.56 / $35.48 / $56.23
| Professional | | $0.56 | $35.48 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.28 / $16.60 / $26.30
| Professional | 26 | $0.28 | $16.60 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.30 / $19.05 / $29.51
| Professional | TC | $0.30 | $19.05 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $34.67 / $53.70
| Professional | | $31.62 | $34.67 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $16.60 / $25.70
| Professional | 26 | $15.14 | $16.60 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $18.20 / $27.54
| Professional | TC | $16.60 | $18.20 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $46.77 / $66.07
| Professional | | $28.18 | $46.77 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $17.38 / $28.84
| Professional | 26 | $14.13 | $17.38 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $26.92 / $37.15
| Professional | TC | $15.14 | $26.92 | $37.15 |