- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $26.92 / $52.48
| Professional | | $19.95 | $26.92 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $20.89 / $25.70
| Professional | 26 | $16.98 | $20.89 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $28.18
| Professional | TC | $3.02 | $3.98 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $31.62 / $52.48
| Professional | | $18.62 | $31.62 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $26.30 / $33.11
| Professional | 26 | $17.38 | $26.30 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1.20 / $5.25 / $23.44
| Professional | TC | $1.20 | $5.25 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $32.36 / $42.66
| Professional | | $15.85 | $32.36 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $38.90 / $52.48
| Professional | | $28.84 | $38.90 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $30.90 / $38.90
| Professional | 26 | $23.99 | $30.90 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.63 / $5.89 / $15.85
| Professional | TC | $2.63 | $5.89 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $35.48 / $51.29
| Professional | | $23.99 | $35.48 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $29.51 / $34.67
| Professional | 26 | $19.95 | $29.51 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $4.17 / $5.89 / $8.32
| Professional | TC | $4.17 | $5.89 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $27.54 / $40.74
| Professional | | $5.50 | $27.54 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $26.92 / $54.95
| Professional | | $21.38 | $26.92 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $20.42 / $30.90
| Professional | 26 | $17.38 | $20.42 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.31 / $4.68 / $34.67
| Professional | TC | $3.31 | $4.68 | $34.67 |