- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $28.84 / $39.81
| Professional | | $23.99 | $28.84 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $22.91 / $28.84
| Professional | 26 | $16.98 | $22.91 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.00 / $3.98 / $8.91
| Professional | TC | $2.00 | $3.98 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $29.51 / $32.36
| Professional | | $4.79 | $29.51 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $27.54 / $27.54
| Professional | 26 | $20.89 | $27.54 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $4.37 / $4.37 / $12.59
| Professional | TC | $4.37 | $4.37 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $32.36 / $128.82
| Professional | | $22.91 | $32.36 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $21.88 / $107.15
| Professional | 26 | $17.38 | $21.88 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1.38 / $11.75 / $30.90
| Professional | TC | $1.38 | $11.75 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $57.54
| Professional | | $31.62 | $31.62 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $50.12
| Professional | 26 | $26.92 | $26.92 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $4.68 / $4.68 / $7.59
| Professional | TC | $4.68 | $4.68 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $31.62 / $63.10
| Professional | | $20.89 | $31.62 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $19.95 / $52.48
| Professional | 26 | $13.18 | $19.95 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.95 / $4.27 / $33.88
| Professional | TC | $2.95 | $4.27 | $33.88 |